the changing organization, knowledge gaps and … r. robertson organizational resources counselors,...

Authors (NORA Organization of Work Team Members)

Steven L. Sauter NIOSH—Team LeaderW. Stephen Brightwell NIOSHMichael J. Colligan NIOSHJoseph J. Hurrell, Jr. NIOSHTheodore M. Katz NIOSHDavid E. LeGrande Communications Workers of AmericaNancy Lessin Massachusetts AFL-CIORichard A. Lippin USA MEDDACJane A. Lipscomb University of MarylandLawrence R. Murphy NIOSHRobert H. Peters NIOSHGwendolyn Puryear Keita American Psychological AssociationSydney R. Robertson Organizational Resources Counselors, Inc.Jeanne Mager Stellman Columbia UniversityNaomi G. Swanson NIOSHLois E. Tetrick University of Houston

DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Institute for Occupational Safety and Health

Knowledge Gaps and Research Directions

The Changing Organizationof Work and the Safety andHealth of Working People

The Changing Organizationof Work and the Safety andHealth of Working People

DisclaimerMention of any company or product does not constitute endorsementby NIOSH.

Ordering InformationTo receive documents or more information about occupational safetyand health topics, contact the National Institute for OccupationalSafety and Health (NIOSH) at

NIOSH—Publications Dissemination4676 Columbia ParkwayCincinnati, OH 45226–1998

Telephone: 1–800–35–NIOSH (1–800–356–4674)Fax: 513–533–8573E-mail: [email protected]

or visit the NIOSH Web site at www.cdc.gov/niosh

DHHS (NIOSH) Publication No. 2002–116

April 2002

This document is in the public domain and may be freelycopied or reprinted.

ii

Foreword

Throughout its thirty years as the Nation’s primary research agency for worker safety and

health, NIOSH has played a vital role in improving safety and health in the workplace. How-

ever, much remains to be done and new challenges are always on the horizon. This is certainly

the case with the organization of work.

Since its inception, NIOSH has been committed to understanding and preventing hazards

arising from the organization of work. In the 1970s, NIOSH was a partner in the Quality of

Employment Surveys and initiated seminal epidemiologic studies on the effects of organiza-

tion of work factors. Subsequently, NIOSH recognized stress at work as a leading safety and

health problem and launched a series of initiatives to investigate and control this problem.

Working with the American Psychological Association (APA), NIOSH has supported interna-

tional conferences on work, stress, and health and postgraduate and graduate training pro-

grams combining organization of work with occupational safety and health at major universi-

ties. NIOSH also collaborated with the APA and other partners to establish the Journal of

Occupational Health Psychology to explore these issues. But sweeping changes in the organi-

zation of work in recent years have increased the stakes and now call for bold new action.

In 1996, the National Occupational Research Agenda recognized organization of work as

one of the 21 priority research topics for the next decade, and a multidisciplinary team of

researchers and practitioners from government, industry, labor, and academia was assembled

to craft the research agenda presented in this report. Simultaneously, a concerted effort was

made to expand and strengthen both the extramural and intramural NIOSH programs in this

area. We have increased extramural funding to universities for research on the organization of

work and enhanced the visibility of “organizational science” within NIOSH.

We are confident that these measures will serve to energize urgently needed research on

safety and health in the changing workplace. I commend to you the present report—not as a

final definitive statement on research needs, but as a framework for a national agenda to

iii

elevate organization of work research to a higher priority in occupational safety and health, to

provide guideposts for research direction, and to develop partnerships in support of these

pursuits.

Kathleen M. Rest, Ph.D., M.P.A.Acting DirectorNational Institute for Occupational Safety and HealthCenters for Disease Control and Prevention

Foreword

iv

Revolutionary changes in the organization of work have far outpaced our knowledge aboutthe implications of these changes for the quality of working life and for safety and health onthe job. This gap in knowledge is one of the 21 priority areas for research under the NationalOccupational Research Agenda (NORA)—a framework crafted by the National Institute forOccupational Safety and Health (NIOSH) and its partners to guide research into the nextdecade. This report was developed under NORA as the first attempt to develop a compre-hensive research agenda for investigating and reducing occupational safety and health risksassociated with the changing organization of work. Research and development needs identi-fied in the agenda include (1) improved surveillance mechanisms to better track how theorganization of work is changing, (2) accelerated research on safety and health implications ofthe changing organization of work, (3) increased research focus on organizational interven-tions to protect safety and health, and (4) steps to formalize and nurture organization of workas a distinctive field in occupational safety and health.

Abstract

v

Organizational practices have changed dramati-cally in the new economy. To compete more effec-tively, many companies have restructured themselvesand downsized their workforces, increased their reli-ance on nontraditional employment practices that de-pend on temporary workers and contractor-suppliedlabor, and adopted more flexible and lean produc-tion technologies.

Fears have been raised that these trends areresulting in a variety of potentially stressful or haz-ardous circumstances, such as reduced job stabil-ity and increased workload demands. Data suggest,for example, that working time has increased dra-matically in the last two decades for prime-ageworking couples, and that workers in the UnitedStates now log more hours on the job than theircounterparts in most other countries. On the otherhand, the increased flexibility, responsibility, andlearning opportunities seen in many of today’s jobsmay hold potential for improved satisfaction andwell-being in the workforce. In reality, however,the revolutionary changes occurring in today’sworkplace have far outpaced our understanding oftheir implications for work life quality and safetyand health on the job.

This gap in knowledge about safety and healtheffects of the changing organization of work hasbeen recognized as one of the 21 priority areas forresearch under the National Occupational ResearchAgenda (NORA). NORA represents a concerted

process by the National Institute for OccupationalSafety and Health (NIOSH) and its partners totarget and coordinate occupational safety andhealth research into the next decade. Approxi-mately 500 individuals and organizations outsideNIOSH contributed to NORA, including employ-ers, employees, safety and health professionals,public agencies, and industry and labor organiza-tions.

The present report was developed under NORAas the first attempt in the United States to de-velop a comprehensive research agenda to investi-gate and reduce occupational safety and health risksassociated with the changing organization of work.Four areas of research and development are tar-geted in the agenda.

First, an urgent need exists to implement datacollection efforts to better understand worker ex-posure to organizational risk factors for illness andinjury, and how these exposures may be changing.Since the demise of the Quality of EmploymentSurveys of the 1960s and 1970s, there has beenno way of determining how the demands of workmay be changing, and how these demands vary fromone industry, occupation, or population to another.In this regard, there is a special need for system-atic data collection examining major trends in or-ganizational practices (e.g., new production tech-nologies such as lean production and flexible manu-facturing) that appear to be spreading rapidly

Executive Summary

vi

through the economy and seem to have an impor-tant influence on job demands.

Second, much greater research attention needsto be given to the safety and health effects of promi-nent trends in the organization of work that havearisen in recent years. Process reengineering, orga-nizational restructuring, and flexible staffing areprime examples of practices that are increasinglyprevalent but insufficiently studied from an occu-pational safety and health perspective. For example,despite growing concern that inexperience result-ing from variable and short-term job assignmentsmay place temporary workers at increased risk forillness and injury, little data exist on safety andhealth outcomes among these workers.

This research on effects of new organizationalpractices cannot ignore the changing workforce,which is increasingly populated by women, ethnicminorities, and older workers. Women are dispro-portionately represented in jobs with restrictedbenefits and reduced flexibility, and they accountfor almost all of the growth in working hours.African-American women are twice as likely to beemployed in temporary jobs than in traditionalwork arrangements, and (longer-tenured) olderworkers are at increased risk of displacement withgreater earnings losses. Yet, the interplay of majordemographic trends and the changing organization

of work has received little research attention inthe United States.

Third, the need exists for intervention researchtargeting organizational practices and policies thatmay protect worker safety and health. Improvedmethods are needed to overcome the many ob-stacles confronting intervention research in work-places, and a closer examination is needed of fac-tors influencing the motivation and capacity offirms to implement organizational interventions toprotect worker safety and health.

Finally, progress toward understanding and pre-venting safety and health risks posed by organiza-tional factors will require a much stronger publichealth commitment to this field of study. Stepsneed to be taken to formalize and promote organi-zation of work as a distinctive field of study withinoccupational safety and health, to develop themultidisciplinary training essential for research inthis area, and to improve research funding oppor-tunities. As prescribed by NORA, strategic alliancesamong key stakeholders will be fundamental to ad-vances of this nature. Stakeholders include Fed-eral agencies, industry and labor coalitions, and themany professional disciplines with interests in theorganization of work (e.g., labor studies, econom-ics, organizational behavior, occupational/publichealth, and the job stress field).

vii

Executive Summary

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iiiAbstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vExecutive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viAcknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Changing Organization of Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Concept of Organization of Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Organization of Work and Occupational Safety and Health . . . . . . . . . . . . . . . . . . 3

2 Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Gaps in Surveillance of the Changing Organization of Work . . . . . . . . . . . . . . . . . . 5Surveillance Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Type of Information to be Collected . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Approaches to Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

3 Safety and Health Effects Research . . . . . . . . . . . . . . . . . . . . . . 9Gaps in Research on Safety and Health Effects of the Changing Organization of Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Uncertain Effects of New Organizational Practices . . . . . . . . . . . . . . . . . . . . . 9Organization of Work and the Changing Profile of the Workforce . . . . . . . . . . 12

Safety and Health Effects Research Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

New Organizational Practices, Workplace Effects, and Risk of Illness and Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Effects in Worker Subpopulations: Women, Ethnic and Racial Minorities, and Aging Workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Effects in High-Risk Sectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Contents

ix

4 Intervention Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Gaps in Research on Organization of Work Interventions to Protect Safety and Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Intervention Research Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Effects of Protective Practices and Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Improvement in Intervention Research Methods . . . . . . . . . . . . . . . . . . . . . . 21Implementing Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

5 Challenges Confronting Research Progress . . . . . . . . . . . . . . . . 24References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Contents

x

Acknowledgments

The authors thank the following NIOSH staff for their contributions: Kellie Pierson forconducting literature searches; Judith Riley and Teri Hill for administrative support; SusanFeldmann, Jane Weber, and Anne Hamilton for editorial review; and Vanessa Becks for docu-ment layout and design.

xi

Changing Organization of Work

Advanced industrial countries such as theUnited States have witnessed sweeping changes inthe organization of work that have been influencedby major economic, technological, legal, political,and other forces. Manufacturing jobs continue todecline, giving way to service and knowledge work.Liberalized trade regulations and new informationand computer technologies have enabled morecompanies to operate globally, resulting in intensi-fied price and product competition. In addition,product and service demands are shifting rapidlyamid pressure for higher quality and customizedproducts. In many countries, these trends are oc-curring against the backdrop of an aging and in-creasingly diverse workforce and tightening labormarkets.

Organizational practices have changed dramati-cally in this new economy. To compete more ef-fectively, many large companies have restructuredthemselves by downsizing their workforces andoutsourcing all but core functions. At the sametime, nontraditional employment practices thatdepend on temporary workers and contract laborhave grown steadily. Organizations are also adopt-ing new and flatter management structures thatresult in downward transfer of management respon-sibility and decentralized control, and they areimplementing more flexible and lean productiontechnologies such as just-in-time manufacturing.The rubric “high performance” work systems has

been used to describe and justify many of theseorganizational practices.

For many workers, these trends have resultedin a variety of potentially stressful or hazardouscircumstances, such as reduced job stability andincreased workload. Data suggest, for example, thatthe average work year for prime-age workingcouples has increased by nearly 700 hours in thelast two decades [Bluestone and Rose 1998; DOL1999a] and that high levels of emotional exhaus-tion at the end of the workday are the norm for25% to 30% of the workforce [Bond et al. 1997].Alternatively, increased flexibility, responsibility,and learning opportunity in today’s workplace mayoffer workers greater potential for self-direction,skill development, and career growth, leading toreduced stress and increased satisfaction and well-being.

In reality, these revolutionary changes in theorganization of work have far outpaced our under-standing of their implications for work life qualityand safety and health on the job. This gap in knowl-edge is the subject of discussion here.

1 Introduction

1

. . . revolutionary changes in the organizationof work have far outpaced our understandingof their implications for work life quality andsafety and health on the job.

Concept of Organization of WorkAlthough the expressions “work organization”

or “organization of work” are increasingly used indiscussions of worker safety and health, these ex-pressions have not been formally defined, and lit-erature on this topic is still meager in the occupa-tional safety and health field. As used in this docu-ment, organization of work refers to the work pro-cess (the way jobs are designed and performed)and to the organizational practices (management

and production methods and accompanying humanresource policies) that influence job design. Alsoincluded in this concept of organization of workare external factors, such as the legal and economicenvironment and technological factors that encour-age or enable new organizational practices.

Figure 1 depicts the multilevel concept of or-ganization of work and illustrates the continuitybetween (1) broad economic and public policy andother forces at the national and international level,

2

Chapter 1

Figure 1. Organization of work.

(2) organization-level structures and processes, and(3) job demands and conditions in the workplace.For example, global economic pressures may leadto restructuring and downsizing by companieswhich, in turn, may increase workload demandsand reduce job security for workers.

As explained, organization of work is identi-fied most closely with the work process and withorganizational factors influencing the work process.However, as illustrated conceptually in Figure 2,the present discussion adopts a broader formula-tion of the organization of work that incorporatesboth human resource practices and labor marketcharacteristics. (Note that human resource prac-tices and labor market characteristics are includedamong the organization of work factors in Figure1.) In practice, these elements cannot be excludedfrom discussions of organization of work becausethey are commonly bundled together with workprocess innovations, or they may interact with newwork processes to influence safety and health. Forexample, expanded employee training (a humanresource function) is integral to the success of flex-ible production processes (an aspect of the workprocess). As an example of interplay between la-bor market and work process factors, studies im-ply that increasing job demands or longer workhours may pose disproportionate risk for womenbecause they bear greater domestic responsibilityand therefore experience greater total workloadthan do men [Alfredsson et al. 1985; Heyman2000; UNDP 1995].

Organization of Work andOccupational Safety and Health

Organization of work has been a topic of interestfor some time in specialized areas of occupational

safety and health, especially in the fields of jobstress, industrial fatigue, and ergonomics. For ex-ample, extensive literature links job characteris-tics (e.g., low levels of control and work overload)to job stress and stress-mediated health outcomessuch as cardiovascular disease and psychologicaldisorders [Karasek and Theorell 1990; Sauter et al.1998; Schnall et al. 2000].

However, there is growing appreciation that theorganization of work has broad implications for thesafety and health of workers—not just for stressand stress-related outcomes. The changing organi-zation of work may also directly influence the levelof exposure to physical hazards in the workplace.For example, workers with multiple jobs or ex-tended work shifts might be at risk of exceedingpermissible exposure concentrations to industrial

3

Introduction

Figure 2. Topics encompassed by the organization ofwork.

chemicals. Long work hours and staff reductionsmay increase the risk of overexertion injury.Increased public contact and alternative workschedules (e.g., night work), which are commonin the growing service sector, may expose workersto heightened risk of violence in their jobs.

In addition, worker safety and health might bethreatened by more indirect effects of changingorganizational practices. For example, worker ac-cess to occupational health services and programsmight be adversely affected by organizationaldownsizing or by the growth of defined contribu-tion or voucher-style health benefit programs.These multiple influences of organization of workon occupational safety and health are illustrated inFigure 3.

Little research, however, and few resourceshave been directed toward a fuller examination ofthe safety and health risks (or benefits) of thechanging workplace. Indeed, researchers currentlyhave only limited means to understand how theorganization of work is changing, and studies link-ing organizational changes to safety and health out-comes have been slow to develop. Even more un-common is research on organizational interventionsto protect worker safety and health in the chang-ing workplace.

The present report develops a scientific agendato address occupational safety and health conse-quences of the changing organization of work. Webegin by examining surveillance systems and sug-gesting improvements in these systems to better

track how the organization of work is changing.Second, innovative organizational practices intoday’s workplace are examined, and safety andhealth effects research is proposed to better un-derstand the consequences of these practices.Third, limitations in research on ways to reorga-nize work to protect worker safety and health inthe changing workplace are discussed, and steps toadvance intervention research of this nature areproposed. Finally, challenges confronting re-search on all of these topics are discussed.

Figure 3. Pathways between organization of work andillness and injury.

4

Chapter 1

Gaps in Surveillance of the ChangingOrganization of Work

Our capacity to track or describe changing pat-terns of work is very limited. Thus, we lack themeans to determine whether organization of workfactors that present known threats to worker safetyand health are becoming more or less prevalent inthe workplace; we are unable to identify emergenttrends in the organization of work that may poserisk; and the distribution of organizational hazardsacross industry, occupation, worker demographic,and other relevant sectors cannot be known. Theseknowledge gaps stand as primary obstacles to in-terventions to protect workers from known orga-nizational hazards and to the conduct of studies tobetter understand the safety and health effects ofemergent and suspected organizational hazards.

Unlike the European Union, which has under-taken cross-national surveys of working conditions(including the organization of work) at 5-year in-tervals, few mechanisms exist in the United Statesfor recurrent or systematic investigation of the or-ganizational aspects of working conditions. It isnotable, however, that this type of information wasonce collected in the context of the Quality of

Employment Survey (QES) that was administeredon three occasions during the period 1969–1977.

The Bureau of Labor Statistics (BLS) providesperiodic updates on labor market conditions andother topics relevant to organization of workthrough mechanisms such as the Current Popula-tion Survey (CPS), a monthly sample survey of50,000 households. Examples of information thatis relevant to the organization of work and collectedby BLS through the CPS and other surveys includedata on occupational growth in different sectors ofthe economy, job displacement and layoffs, alter-native employment arrangements (e.g., temporaryhelp agency employment), multiple job holding,earnings and benefits, and hours of work and workschedules. Information about related topics is alsoprovided by other Federal agencies (e.g., CensusBureau and Department of Transportation), pri-vate institutes (e.g., Economic Policy Institute,Families and Work Institute), trade associations(e.g., American Management Association), consult-ing firms (e.g., International Survey Research Cor-poration), and national and international humanand labor rights organizations (e.g., InternationalLabour Office).

Reports from these sources have yielded in-sights on changing patterns of work that may haveimplications for worker safety and health. For ex-ample, a sampling of findings by these groups sug-gests the following: (1) hours of work seem to begrowing steadily across many occupations andworker populations [Bluestone and Rose 1998;

2 Surveillance

5

Our capacity to track or describe changingpatterns of work is very limited.

DOL 1999a; Rones et al. 1997]; (2) telecommutingand work at home are increasing steadily [Bureauof the Census 1998; International Telework Asso-ciation and Council 2000]; (3) the rate of jobgrowth in the temporary help industry appears tofar exceed the rate of overall job growth [CRS1999]; (4) job displacement due to organizationalrestructuring continues to grow [Hipple 1999]; and(5) job tenure has declined for many workers [BLS2000; Neumark et al. 1997].

However, from an occupational health perspec-tive, these data and data collection mechanismsleave much to be desired. Concerns include thefragmentary and discontinuous nature of surveysand variation in definition and measurement ofworking conditions in these surveys (resulting, forexample, in widely discrepant assessments of thenumber of workers in the contingent workforce).Further, systematic data collection is lacking formajor innovations in process management and as-sociated human resource practices (e.g., lean pro-duction methods) that are spreading rapidlythroughout the economy (see Mavrinac et al.[1995] for examples and discussion of these inno-vations).

In addition, at present no Federal or other sys-tematic efforts exist to capture information aboutchanges in specific job characteristics that are knownrisks for stress, illness, and injury. For example, sincethe demise of QES, there has been no way of deter-mining whether job tasks are becoming increasinglyor less repetitive, whether workloads are increasingor decreasing, whether workers have reduced or in-creased control in their jobs, etc., and how thesetrends vary from one industry/occupation or work-ing population to another.

As a further limitation, present surveys address-ing organization of work factors generally collect

little or no collateral data on exposure to otherworkplace hazards or on health outcomes, nor dothey allow organization of work data to be linkedreadily to other exposure data or health data. Thus,these survey efforts cannot be exploited for healtheffects studies on the organization of work. On theother hand, health surveillance efforts (using work-place-centered data such as workers’ compensa-tion files and injury logs or general population sur-veys such as the National Health Interview Sur-vey) usually lack sufficient job data to link safetyand health outcomes to organization of work fac-tors.

Surveillance NeedsAn urgent need exists to implement data col-

lection efforts to better understand worker expo-sure to organizational risk factors for illness andinjury, and how these exposures may be changing.Specifically, these data collection efforts would bedesigned to

— describe changing exposure to organizationof work factors that present known risks forillness and injury,

— detect emerging trends in the organizationof work that pose uncertain or suspectedrisk, and

— describe the distribution of these exposuresand trends within industry, occupation, de-mographic, and other relevant sectors.

In turn, this information would be used to jus-tify and target interventions to reverse hazardoustrends in the organization of work, and to identifyand prioritize organization of work factors for fur-ther study of their safety and health effects.

6

Chapter 2

The design, content, and operation of a nationalsurveillance system for the organization of work isbeyond the scope of the present exercise and shouldbe relegated to a stakeholder panel. However, it ispossible in the present context to outline impor-tant features of such a system.

Type of Information to be Collected

An organization of work surveillance strategymust at least assess organizational factors that haverecognized associations with illness and injury orwith psychological and physical stress at work.Good examples of these factors include job char-acteristics (i.e., Work Context factors in Figure 1),such as work roles and workload demands, degreeof support and control afforded workers, job secu-rity, etc., that have been the subject of extensivestudy in the job stress and psychosocial epidemiol-ogy fields (see Kasl [1992] for a more expansivelisting and discussion of these factors).

In addition, a surveillance strategy for the or-ganization of work should include measuringbroader organizational structures and practices (i.e.,Organizational Context factors in Figure 1) thatare presumed to influence job characteristics andrisk of illness and injury, but whose effects maynot be well understood. Alternative employmentarrangements, organizational restructuring, and el-ements of high performance/lean production worksystems (e.g., participative management strategies,just-in-time inventory control, multiskilling, jobcombination, and team work) are examples of or-ganizational practices that would merit close at-tention in a contemporary organization of worksurveillance system (see Mavrinac et al. [1995] fora more expansive listing and discussion of thesepractices).

Consistent with the causal model in Figure 3,surveillance of organization of work should extendalso to collection of data on workplace safety andhealth programs that may offset adverse effects oforganizational practices. Prime examples of suchprograms include occupational medicine services,employee assistance programs, safety training, andwork-life programs.

Injury and illness information can also be use-ful in the context of organization of work surveil-lance. Although data on changing job characteris-tics and organizational practices alone can yieldinsights regarding risks of changing organization ofwork, such inferences would be strengthened ifthese data could be merged with health surveil-lance data (although merger of these different datasets often proves difficult). Alternately, some sur-veys of changing work experiences (e.g., the BLSNational Longitudinal Survey) include injury andillness inventories and measures of psychologicalwell-being, thereby enabling direct study of therelationship between organization of work expo-sures and health. Similarly, the former QES con-tained measures of perceived stress, job satisfac-tion, and work-family conflict.

From the standpoint of inferring illness andinjury risk, collecting data on physical hazards (e.g.,noise, ergonomic hazards) may also prove usefulsince exposure to these hazards can be influencedby the organization of work and may pose immi-nent threat to safety and health.

Approaches to Data Collection

Several strategies for improving surveillance ofthe organization of work can be proposed. The mostdesirable (and ambitious) approach would be to

7

Surveillance

develop a stand-alone nationally representativesurvey of the organization of work. Such a surveymight be modeled after and expand upon theformer QES. The QES captured much of the keysurveillance data described previously and was ad-ministered on three separate occasions at 4-yearintervals during the period 1969–1977. Preferably,followup administration of a core survey of thisnature would occur at 3- to 5-year intervals, withsupplements to assess emergent conditions of in-terest, such as the recent trend toward telecom-muting and growth of work-life programs. Logi-cally, primary responsibility for such a survey wouldreside with the National Institute for OccupationalSafety and Health (NIOSH) and sister agencies,such as BLS, that have the charge and technicalcapacity for data collection of this nature.

Second, organization of work surveillance couldbenefit from efforts to promote access to existingpublic domain and proprietary data sources thatpertain to the changing nature of work. Thesesources include diverse data sets on the conditionsof work that are developed and maintained by gov-ernment agencies such as BLS, national polling or-ganizations such as the National Opinion ResearchCenter, and trade and industry associations suchas the American Management Association or the

Society for Human Resource Management. TheUniversity of Michigan Panel Study of IncomeDynamics, for example, has proven to be usefulfor analysis of trends in hours of work. Nontradi-tional data sources such as organizational climatedata that are collected periodically within specificorganizations and industries may also hold valuefor surveillance purposes. Researchers also need tobe vigilant to opportunities to influence these datasets by annexing items or suggesting contentchanges to surveys to improve their utility for sur-veillance purposes.

Finally, attention needs to be given to ways toimprove methods and metrics for surveying theorganization of work. A need exists for surveys andmeasures of job characteristics that economize onadministration time, yet have acceptable psycho-metric qualities. A need also exists for develop-ment of improved methods for assessing organiza-tional conditions (such as working hours) that havepresented difficult measurement problems to re-searchers. Additionally, a need exists for improvedstandardization of content across surveys to enablecomparison and aggregation of data. Resolution ofthese methodological and psychometric problemswould serve to benefit health effects research onorganization of work as well as surveillance.

8

Chapter 2

Gaps in Research on Safety andHealth Effects of the ChangingOrganization of Work

Several disciplines have contributed to a steadyaccumulation of research attesting to the impor-tance of organization of work as a determinant ofworkplace safety and health. However, this areaof study remains loosely organized and has beenunable to keep pace with new organizational prac-tices and safety and health concerns raised by thesepractices. This section provides examples of promi-nent trends in the organization of work (includinghuman resource practices) that have arisen in re-cent years and highlights areas of uncertainty abouttheir safety and health consequences. Workforcecharacteristics are treated as an additional andcross-cutting topic of research need because theeffects of these trends cannot be fully understoodwithout considering the changing makeup of theworkforce.

Uncertain Effects of New OrganizationalPractices

Process reengineering, organizational restructur-ing, and flexible staffing are prime examples ofpractices that have swept through industry in re-cent years but have been insufficiently studied froman occupational safety and health perspective. Inthe following discussion these practices and otherprominent developments (e.g., telecommuting and

work at home, and the trend toward longer workhours) are examined together with gaps in under-standing how they may influence the jobs, safety,and health of workers.

Reengineering of production processes

Beginning in the mid-1980s, organizations inthe United States invested heavily in innovativeproduction processes to foster improvements inquality and efficiency and increase their ability torespond rapidly to changing market demands. Vari-ous names have been given to these new work sys-tems, including high performance and high involve-ment work systems, flexible workplace practices,total quality management (TQM), and lean pro-duction. Theoretically, and in contrast to massproduction technologies and traditional com-mand and control management systems, thesetypes of work systems seek to capitalize on theingenuity, creativity, and problem-solving abilityof workers to make the production process moreefficient. High performance or high involvementwork systems profess to shift decision-making

3 Safety and Health Effects Research

9

Process reengineering, organizationalrestructuring, and flexible staffing areprime examples of practices that haveswept through industry in recent years buthave been insufficiently studied from anoccupational safety and health perspective.

authority downward to teams of workers who aretrained to be proficient in a variety of tasks. TQMand lean production try to reduce production im-pediments by using process simplification to elimi-nate wasted time and motion, paring inventoriesthrough just-in-time methods, and by emphasiz-ing continuous improvement. In principle, TQMand lean production give greater voice to workersto achieve these goals, but generally, this influenceextends to problem solving at the point-of-produc-tion only. A hierarchical management structure maystill be retained.

Aspects of high performance and lean produc-tion work practices seem to be spreading rapidlythroughout the economy. Surveys suggest 30% to50% of organizations with 50 or more workers en-gage in teamwork [Gittleman et al. 1998; Kaminski2001; Osterman 1994], 25% of these organizationspractice job rotation [Gittleman et al. 1998;Osterman 1994], and 25% to 50% employ TQMpractices [Gittleman et al. 1998; Osterman 1994].

On the surface, these practices resemble posi-tive principles of work organization (i.e., empha-sizing worker autonomy, task variety, learning op-portunities, etc.) that are highlighted in job enrich-ment theory and contemporary models of healthywork [Karasek and Theorell 1990]. Thus theywould appear to hold promise for improvementsin worker health and organizational performance.However, the limited research data on these prac-tices are less encouraging, showing mixed effectson employee empowerment or control and raisingfears of work intensification. Further, studies oflean production in the automotive industry dem-onstrate increased risk of musculoskeletal disor-ders although evidence of adverse outcomes inother industrial settings is more equivocal (see

Landbergis et al. [1999] and Smith [1997] for asummary of these concerns and findings).

Additional study is needed to permit generali-zations regarding safety and health effects of thesenew work systems and to gain insights regardingcircumstances under which they promote safe orunsafe and healthy or unhealthy work. Since, inpractice, these work systems are seldom imple-mented in a standardized fashion, their effects onworker safety and health may depend on their spe-cific characteristics and the implementation pro-cess.

Organizational Restructuring and Downsizing

Organizational downsizing reached record lev-els by the early 1990s, when a third or more ofmajor organizations engaged in broad workforcereductions on a yearly basis [AMA 1997]. Althoughrisk of job displacement receded steadily in subse-quent years [AMA 2000; Hipple 1999], the presenteconomic downturn has produced a new wave ofworkforce reductions as confirmed by BLS datashowing a substantial increase in mass layoffs in2001 [BLS 2001]. Also, the fraction of job lossdue to structural reasons (abolishment of positionsor shifts) has continued to grow over the last twodecades and presently accounts for 25–30 percentof all job displacement [Hipple 1999]. The con-tinuing risk of involuntary job displacement hascoexisted with periods of brisk job creation thathas resulted in high levels of turnover due to vol-untary separations [BNA 2000]. This volatility inthe recent job market poses a threat to stable andlong-term relationships between employers andworkers. Recent analyses indicate declining jobstability from the 1980s to the 1990s for maleworkers and longer-tenured workers, and to the

10

Chapter 3

early 1990s for African American workers [BLS2000; Neumark et al. 1997].

These trends raise multiple questions and con-cerns that have received only sparse study. Too littleis known about the safety and health risks to work-ers who face or survive episodes of downsizing, orthe effects of downsizing and outsourcing on thecapacity of organizations to provide occupationalhealth services and programs for workers. Also,concern exists that high rates of job destructionand creation in an organization may threaten itsability to accumulate and store safety knowledge.High rates of job destruction and creation may alsolead to high levels of stress from chronic employ-ment uncertainty, particularly since the jobs cre-ated may not provide the same level of compensa-tion and benefits nor the same quality of workingconditions.

Flexible Staffing and Other HumanResource Innovations

Agency-supplied temporary workers and work-ers in other alternative employment arrangements(independent contractors, contractor-supplied la-bor, and on-call workers) constitute nearly 10% ofthe workforce according to data from the BLS CPS[DiNatale 2001]. Data from the BLS CurrentEmployment Statistics Survey (CES) and othersources suggest, however, that the temporary helpsector of the economy is larger than reflected inthe CPS and has been growing steadily [Brogan2001; CRS 1999; Franklin 1997; Houseman 1997].According to the CES, for example, the total num-ber of jobs in the temporary help industry multi-plied 6-fold to nearly 3 million during the period1982–1998, whereas total employment during thisperiod grew about 40% [CRS 1999; GAO 2000].

Flexible employment practices seem to resultfrom strategic efforts by organizations to adjuststaffing in response to fluctuating market demands,seasonal needs, and absent permanent workers. Atthe same time, labor costs are contained by relyingon a contingent workforce to whom the organiza-tion has minimal or no obligation for long-termemployment, benefits, training, or responsibilitiesunder labor law [CRS 1999; DOL 1999b; House-man 1997; Jorgensen 1999; Peck and Theodore1998]. Increased labor supply from youth, women,and aging workers (who may not always desire long-term employment relationships) may also contrib-ute to the upward trend in temporary employment.

Little is known, however, about the impact offlexible employment practices on worker safety andhealth, and a host of concerns have been raised.Proponents of alternative employment arrange-ments point to flexible scheduling (that can leadto improved work-life balance) and avenues topermanent employment as potential benefits forworkers. Critics charge, however, that flexibleemployment practices are leading to a downwardrestructuring of the labor market that evades legaland contractual obligations to workers and exposesthem to financial and health risks. In this regard,statistics show that most agency-supplied tempo-rary workers do not prefer temporary employment,and they are less likely than traditional workers toreceive health or pension benefits [DiNatale 2001;Houseman 1997]. Concern also exists that organi-zations may shift hazardous jobs and tasks to mem-bers of the alternative workforce, that these work-ers may be less likely to recognize and report haz-ards and injuries, and that they may be at increasedrisk of stress owing to precarious employment.

11

Safety and Health Effects Research

However, speculation far outstrips the empiricaldata on all of these concerns. For example, despitethe strong growth in temporary employment sincethe mid-1980s, empirical study of safety and healthexperiences among temporary workers is scarce.

Other human resource programs have emergedin recent years and may ease or exacerbate risk ofstress, illness, and injury among workers. Examplesinclude incentive pay systems (e.g., gainsharing),defined contribution and self-managed health ben-efits, work-life programs (e.g., flexible work ar-rangements, dependent care programs, conciergebenefits), and absenteeism polices that penalizeworkers for taking any type of leave. However, likeflexible staffing arrangements, the implications ofthese practices for worker safety and health havereceived little investigation.

Long hours of work

American workers are spending more and moretime on the job. Especially dramatic is the steadyincrease in working hours for women and prime-age working couples, the latter contributing nearlyfour additional months of annual work time sincethe 1970s [Bluestone and Rose 1998; DOL 1999a].Average annual working hours in the United Statespresently exceed the average for Japan and all ofWestern Europe, except for the Czech Republicand Hungary [ILO 1999]. Evidence of risk to safetyand health from long hours of work is found in theresearch literature [Hanecke et al. 1998; Rosa1995; Spurgeon et al. 1997]. In a recent study ofGerman workers, an exponential increase in injuryrisk was observed beyond the 9th hour of work[Hanecke et al. 1998]. However, the body of re-search literature on safety and health effects of longwork hours is surprisingly small. Furthermore, little

is known about the interaction of long work hourswith demanding work schedules (nightwork,shiftwork, etc.), with different job characteristicsand exposures, with the intensification of work,and with mandatory and unplanned overtime.

Other key developments—new technology,telecommuting, and home work

Although home work is not new, increasingnumbers of people are working from home orvirtual workplaces, aided by new computer andcommunications technologies. Extrapolationfrom various surveys suggests that the numberof telecommuters has increased dramatically to16 million workers or more during the decade ofthe1990s [DOT 1993; International Telework As-sociation and Council 2000; Kensington Technol-ogy Group 1998], although these numbers under-estimate the prevalence of work at home in gen-eral [Edwards and Field-Hendrey 1996]. This trendtoward a seamless work-life paradigm revisits ques-tions about safety and health in home work. Onone hand, home work and telecommuting arrange-ments may reduce stress and injury risk by harmo-nizing work and family demands and minimizingdaily commutes. Balanced against these presumedbenefits are risks from loss of safety oversight, in-troduction of occupational hazards into the homeenvironment, blurring of work and family roles, andisolation from peers yet feeling constantly tetheredto the workplace.

Organization of Work and the ChangingProfile of the Workforce

Researchers acknowledge that the occupationalsafety and health field, including the job stress lit-erature, has not given due attention to the special

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Chapter 3

circumstances and risks encountered by women[Stellman 1999] and by racial and other minoritypopulations in the workforce [Frumkin and Pransky1999]. Present trends in the organization of workand employment create an even more acute needto attend to these populations. For example, evi-dence shows that (1) women are disproportion-ately represented in the growing service sector[DOL 2001a] and in less favorable jobs (lower paywith restricted benefits and flexibility) [Beers2000; DOL 2001b; Heyman 2000]; (2) they ac-count for almost all of the recent growth in work-ing hours [Bluestone and Rose 1998; DOL 1999a];and, (3) as their presence in the workplace has in-creased, their risk of job displacement has surpassedthe risk for men [Hipple 1999]. Also, the growingpool of agency-supplied temporary labor is dis-proportionately young, female, and African-American. African-American women, for example,constitute 21% of the workforce provided by tem-porary help firms—nearly twice their representa-tion in the traditional workforce [DiNatale 2001].

Nonetheless, few studies have investigated theimplications of the changing organization of workfor the safety and health of women and minoritypopulations. To what extent do these employmentcircumstances expose women and minorities tohazardous work and the stresses of marginal em-ployment? To what extent do their jobs provideotherwise unavailable access to the benefits ofemployment? What are the net effects on workersafety and health?

Changes in organization of work also interactwith the aging of the workforce to raise questionsregarding safety and health risk. The population ofworkers 55 and older is projected to grow muchfaster than the population of workers aged 25–54[Fullerton 1999] and, among longer-tenured

workers (3 or more years tenure), this older groupis at higher risk for displacement with greater earn-ings losses [Helwig 2001; Hipple 1999]. Research-ers have not investigated the safety and healthimplications of these and other circumstancesamong older workers. It is unclear, for example,whether evolving organizational practices (such aslong work hours and new production methods in-volving teamwork, continuous improvement andlearning, etc.) create special risks and safety andhealth training needs for aging workers. In this re-gard, concern exists that lean production practicesmay be leading to reduced availability of lighterduty jobs for older workers [Lewchuk andRobertson 1996]. Such risks could be exacerbatedin workplaces that are disproportionately populatedby older workers as a result of seniority systems.

Safety and Health EffectsResearch Needs

Our limited understanding of risks posed bytoday’s turbulent work environment illustrates theneed for a more expansive program of research onthis topic. In particular, research is needed to bet-ter understand how emerging trends in organiza-tional practices influence job demands, employeedevelopment, hazard exposures, health services,worker behaviors, work-family balance, and otherconditions that may influence risk of stress, illness,and injury in the workforce. In this section weprovide some examples of specific research needs

13


. . . few studies have investigated the implica-tions of the changing organization of workfor the safety and health of women andminority populations.

targeting the effects of new organizational prac-tices on job conditions and, in turn, on the safetyand health of workers. The section begins, how-ever, with a discussion of broader directives forsafety and health research on the changing orga-nization of work.

Of primary significance, evidence points to bothpositive and negative effects of changing organiza-tional practices [Berg 1999; Jackson and Martin1996; Jackson and Mullarkey 2000; Kaminski2001; Landsbergis et al. 1999; Smith 1997; Sprigget al. 2000]. These mixed findings suggest that animportant focus of research should be the clarifi-cation of circumstances (for whom and under whatconditions) in which these practices protect work-ers or place them at increased risk.

Also, research on effects of changing organiza-tional practices should include a wide range of out-comes, including safety risks and associated inju-ries. Safety outcomes have been particularly ne-glected in prior research. Additional outcomes(such as disability, health care and employee assis-tance program utilization, socioeconomic costs, andwork-family conflict) should be studied in orderto portray more fully the burden of illness and in-jury associated with organizational stressors.

Finally, research on safety and health effects oforganizational factors needs to overcome method-ological difficulties that are common, but certainlynot unique, to this field of study. Most widely rec-ognized is the need for increased use of prospec-tive study designs to overcome limitations in causalinference with cross-sectional studies. Exposureassessment presents special challenges in this fieldof study. To begin with, improved standardizationof exposure measures and methods is needed toenable comparisons across studies. Multimethodestimates of exposure are needed to help improve

validity and overcome the risk of contamination ofquestionnaire or other self-report exposure mea-sures by present health status or other factors. Aparticular need exists for methods to assess morereliably organizational practices (e.g., quality im-provement) that are commonly measured only atthe organizational level through key informants. Atthe same time, a need exists for economy in expo-sure assessment strategies so organizational prac-tices can be assessed efficiently in large-scale epi-demiologic studies. Finally, more work is neededto develop job exposure matrixes to obtain mean-ingful estimates of exposures to organization ofwork factors among today’s workers whose careersare increasingly punctuated by job transitions.

New Organizational Practices, WorkplaceEffects, and Risk of Illness and Injury

Emerging evidence and accounts by workersand managers suggest effects of new organizationalpractices on job conditions and exposures that mayinfluence the risk of stress, illness, and injury. Ex-amples of these effects that need further studyinclude the following:

Work pressures and demands

� Evidence points to a steady increase in workloadover the last two decades [Bond et al. 1997]. Re-search is needed to investigate organizational prac-tices that may contribute to the intensification ofwork and to examine the implications for workersafety and health. Examples of such practices in-clude the spread of high performance/lean produc-tion work systems and teamwork structures thatmay lead to work intensification through processessuch as the following:

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Chapter 3

1. Increased worker responsibility and ac-countability for production managementand meeting production goals.

2. Increased vigilance (process monitoring) andproblem solving demands.

3. Increased electronic monitoring.

4. Increased peer-monitoring and competitionwithin teams.

5. Increased role demands or conflict (owingto multiple roles and blurring of managerand worker roles).

6. Demand for flexibility and continuouschange.

7. Speedup and reduction in idle time.

Other potential sources of work intensification inneed of study include overwork motivated by (a)the trend toward putting increasing amounts of payat risk (pay for performance), (b) vulnerability tolabor market risks (e.g., low pay, risk of job loss)among temporary workers, or (c) fear of displace-ment resulting from organizational restructuringand downsizing. Additionally, better understand-ing is needed of the risks and effects of work over-load resulting from staffing reductions followingorganizational downsizing. At the same time, re-search is needed to investigate whether increasedlevels of worker control and learning provided bynew work systems can offset adverse effects of in-tensified demands in today’s workplace.

� Research is needed to investigate factors thatmay contribute to lengthening of work hours (e.g.,substitution of overtime for new employment,communication technologies and organizationalpractices that make work impervious to time and

geographical boundaries) and risks of injury andillness brought about by the demands and fatigueof long work hours. Particularly pressing is the needfor research on the following:

1. Effects of modest increases in workinghours.

2. How effects of long work hours might bemodified by alternative work schedules andwork-rest regimens, and varying domesticdemands.

3. Task-specific effects of long work hours(e.g., effects of long work hours for physi-cally demanding tasks and other hazardousexposures).

4. The effects of unplanned and mandatoryovertime.

Studies need to develop improved methods formeasurement of working hours, give much moreattention to safety outcomes, and focus on popu-lations most likely to work long hours.

Worker empowerment and development

� Research is needed to better understand hownew work systems affect workers’ capacity toinfluence job conditions and opportunities forlearning and growth and, in turn, the impact onsafety and health in the workplace. Increasedworker control and learning opportunities arerecognized in the job stress literature as power-ful antidotes to stress and illness. But concernexists that various worker participatory or in-volvement strategies may often be more ceremo-nial than substantive, having little meaningfulinfluence on worker empowerment—or perhaps

15


even eroding workers’ means to influence job con-ditions through more traditional labor-managementmechanisms such as collective bargaining. Concernalso exists that cross-functional teamwork and jobenlargement strategies may in some instances mul-tiply the number of tasks workers perform withlittle net effect on worker competencies.

Occupational health services and programs

� Research is needed to better understand howoccupational health services and programs, includ-ing worker safety training, and access to these ser-vices and programs are affected under organiza-tional restructuring and downsizing. Some indica-tion exists, for example, that utilization of em-ployee assistance programs may drop significantlywhen these programs are outsourced to off-sitevendors [Collins 1999]. Additionally, informationis needed on the effects of loss of health benefitsamong the substantial proportion of displacedworkers who become re-employed but experienceloss of health insurance and wage reductions.

� Only a fraction of temporary workers and othermembers of the alternative workforce enjoy accessto company-provided health benefits, and accessto occupational health services and programs hasnot been studied among these workers. Researchis needed to better understand gaps in the deliv-ery of occupational health services to these work-ers. Additionally, research should examine thesafety and health implications of the emergingtrend toward defined contribution and self-managed health benefit programs that may limithealth services available to members of the tradi-tional workforce.

Worker safety knowledge and behavior

� Research is needed to investigate effects ofchanges in the organization of work on the fund ofsafety knowledge available to workers and organi-zations. Examples of relevant questions for inves-tigation include the following:

1. Are downsizing and employment volatilitycreating safety and health risks by deplet-ing institutional knowledge of safety andhealth practices through loss of experiencedworkers and managers—or, correspondingly,is high labor turnover interfering with work-ers’ ability to acquire safety skills and knowl-edge?

2. To what extent is job combination, evenamong seasoned workers, adding tasks forwhich workers lack safety knowledge?

3. To what extent do temporary workers faceincreased risk of illness and injury from in-experience or insufficient safety training ow-ing to variable and short-tenure job place-ments?

Evidence of substantially increased injury inci-dence among inexperienced workers [BLS 1999;CDC 2001; Goodman and Garber 1988] adds ur-gency to the need for studies addressing these ques-tions. Studies of workers with new jobs and tasksneed to investigate not only risks posed to them-selves, but to their peers as well.

� Studies are needed to examine the effects ofnew work systems and work intensification on thetime and opportunity to exercise safe work prac-tices.

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Chapter 3

� Research is needed to investigate whether per-ceptions of insecure employment among contin-gent workers or traditional workers at risk of dis-placement discourages the reporting of hazards, in-juries, and illnesses or the utilization of health care.

Hazard exposures

� Research is needed to assess whether alterna-tive employment arrangements, such as temporaryand contract work, result in differential work as-signments involving elevated exposures to occupa-tional hazards. Similarly, research is needed to in-vestigate whether job insecurity might motivateworkers to accept more hazardous job duties.

� Little evidence exists of organizational invest-ment in safety training and assessment of workingconditions for home workers and telecommuters.Research is needed to better characterize hazard-ous exposures attendant to homework, includingtelecommuting by white-collar and knowledgeworkers.

Work-life balance

� Accelerated research is needed on effects oftelecomuting and other organizational practicesthat meld work and family life, considering boththe benefits presumed to result from increasedflexibility and control over family obligations andrisks from insufficient separation of work and fam-ily. Specific attention needs to be given to the riskof stress and family dysfunction from spillover ofwork demands into the family environment fortelecommuters and home workers, and to tech-nologies and organizational policies that promoteor discourage intrusion of work into personal

spaces. Similarly, study is needed of the sourcesand effects of work disruption and potential safetyand health risks resulting from conditions in thehomes of telecommuters and home workers.

� Work-life programs and family-friendly policiesto reduce work-life conflict have spread rapidlythroughout industry, but empirical study of theirhealth-related effects is sparse. Research is neededto investigate the effects of these programs andprogram attributes on preventing work-family con-flict and stress among workers.

Other effects—access to legal protection andorganizational supports

� Many workers who do not participate in thetraditional (full-time, direct hire) workforce falloutside the boundaries of a myriad of statutes andpolicies to protect the rights and welfare of work-ers, including protection from discrimination, rightsto overtime pay and minimum pay, rights to col-lective bargaining, etc. Research is needed to un-derstand the impact of these limitations on thesafety and health of workers who participate in al-ternative employment arrangements. Many of theseworkers also do not receive comparable pay, fringebenefits, and access to the career ladders and orga-nizational resources available to members of thetraditional workforce. Research needs to begin toexplore how these constraints may play out overthe long term to affect the well-being of workers.

� As the social contract between employers andemployees changes, workers are increasingly re-quired to assume greater personal responsibilityfor their continuity of employment. Researchneeds to examine how these new demands may

17


influence stress and well-being in today’s work-force.

� Research is also needed on the potential stressesamong home workers and telecommuters createdby nonstandard work schedules, role conflicts, andthe possible loss of identity, security, status, andsupport from peers and supervisors that may re-sult from inability to participate in the social envi-ronment of the organization.

Effects in Worker Subpopulations: Women,Ethnic and Racial Minorities, and AgingWorkers

Research needs to examine much more vigor-ously the effects of organizational stressors, suchas harassment and job discrimination, that arehighly specific to women and ethnic and racialminorities. Studies are also needed to better un-derstand how employment arrangements morecommon among women and certain minoritygroups in today’s economy (e.g., service work, tem-porary employment, home work) may dispropor-tionately expose them to occupational risks, suchas reduced health benefits and job insecurity. Atthe same time, studies need to investigate possibleprotective effects of these employment arrange-ments that may derive from increased access toemployment, or the flexibility needed to balancework and personal or family demands more effec-tively.

Research is also needed to investigate whetherthe adjustments, learning demands, and workloadpressures that may be created by new work sys-tems and rapid technological advances place olderworkers at heightened risk of stress, illness, andinjury. Studies of new job demands among olderworkers also need to examine the contribution offactors such as unavailability of light-duty work andincreased probability of displacement to risk ofstress, illness, and injury among these individuals.

Effects in High-Risk Sectors

An especially urgent need exists for researchattention to industry sectors and occupations thathave been subjected to sweeping organizationalchanges in recent years. For example, efforts to-ward cost containment in the health care sectorhave resulted in dramatic organizational changesinvolving staff reductions and a changing skill mix,long hours of work and mandatory overtime, andnew work role demands as health care deliveryshifts from a fee-for-service inpatient model to anoutpatient managed care model. Although consid-erable attention has focused on the adverse effectsof these widespread and abrupt changes in workpractices on patient care [Aiken et al. 2001; Kohnet al. 2001], the effects of these changes on thesafety and health of health care workers have re-ceived little study.

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Chapter 3

Gaps in Research on Organization ofWork Interventions to Protect Safetyand Health

The scientific literature provides relatively fewexamples of occupational safety and health inter-ventions that feature the reorganization of work.One exception is a fairly small body of research onreducing job stress that looks at effects of inter-ventions such as work rescheduling, workload re-duction, role clarification, and the redesign of jobsto improve worker decision-making and autonomy(see Parkes and Sparkes [1998] for a review of thisliterature). This research base is substantially en-larged if the broad literature is considered onsociotechnical design that examines effects of or-ganizational interventions on related outcomes suchas employee satisfaction and morale [Ilgen 1990;Locke and Schweiger 1979; Schneider 1985]. Ad-ditionally, studies of occupational safety programsare found in the safety literature [Cohen andColligan 1998; Hugentobler et al. 1990; OSHA1998] although classifying many of these programsas organization of work interventions may be inap-propriate.

Review of this intervention research literatureleads to several broad conclusions. First, as noted,the body of literature on interventions to changeaspects of job design or organizational practices toreduce exposures to job hazards is small. In the jobstress arena, this research base is much smaller than

the body of research on individual-level interven-tion strategies, such as stress management andhealth promotion, that seek to improve the capac-ity of workers to withstand demanding or hazard-ous job situations [Murphy 1996].

Second, the extent to which many of these or-ganization of work interventions improved workersafety and health is questionable. Small, inconsis-tent, and short-term effects of interventions arecommonly reported, although these problems aremore often found in the health literature than inthe safety intervention literature. In their recentreview of job stress intervention studies, Parkes andSparkes [1998] concluded that “. . . the studies donot present a convincing picture of the value oforganizational interventions designed to reducework stress . . . and tend to be difficult to inter-pret, causally ambiguous, inconsistent, based onsmall samples, and/or statistically nonsignificant”.These conclusions were particularly true of par-ticipatory action research interventions; of the fivesuch studies reviewed, not one demonstrated strongand favorable results.

4 Intervention Research

19

The scientific literature provides relativelyfew examples of occupational safety andhealth interventions that feature thereorganization of work.

Third, the organization of work interventionliterature is beset by various methodological prob-lems, especially the absence of strong study de-signs involving randomized trials, making evalua-tion and attribution of outcomes difficult. As dis-cussed in a recent commentary on research on pre-vention of occupational injuries [Rosenstock andThacker 2000], such methodological shortcomingsare pervasive in the occupational safety and healthintervention literature.

On the other hand, strong designs are some-times not feasible in intervention research becauseof practical, ethical, legal, or other constraints. Forexample, organizations are changing so quickly inresponse to technological innovations and marketconditions, it is often difficult to achieve the de-gree of stability needed to maintain control groupsessential to experimental evaluation of interven-tions. At a more theoretical level, it has also beenargued that organizations cannot be readily changedor improved by attempts to systematically manipu-late their individual parts, and thus conventionalscientific approaches may not be faithful to thetrue dynamics of the organizational change process[Colarelli 1998]. These circumstances representsubstantial obstacles to rigorous study designs inintervention research and have led to the adoptionof quasi-experimental methods in some cases andto the use of action research methods in others.

Finally, in addition to gaps in intervention ef-fectiveness research, little is known about imple-menting interventions within organizations. Evi-dence suggests that benchmarking and other prac-tices that are not necessarily evidence-based playan important role in adopting and diffusing organi-zational interventions (in contrast to the publichealth model, which proceeds methodically from

problem identification to intervention and evalua-tion). However, these practices are not well un-derstood. Absence of better information about thedecision processes underlying organizational inter-ventions thus becomes an important impedimentto promoting safety and health interventions forworkers.

Intervention Research NeedsTo close these gaps in research on organization

of work interventions, advances are needed alongseveral fronts: (1) a substantial increase in researchis needed on organizational practices and policiesthat may serve to protect worker safety and health;(2) methodological advances in intervention re-search are needed in support of these studies; and(3) a closer examination is needed of factors thatinfluence the implementation of interventionswithin organizations.

Effects of Protective Practices and Policies

Three categories of intervention research needsare most evident. First, intervention research isneeded that develops remedies to hazards identi-fied in health effects studies of the changing orga-nization of work. Naturally, this research shouldtarget those organizational changes that create thehighest apparent risk for stress, illness, and injury.In this regard, studies of the safety and health ben-efits of interventions targeting practices such asorganizational restructuring/downsizing, long hoursof work, and work intensification could be recom-mended.

Second, a need exists to more aggressively in-vestigate the effects of organizational interventionsalready occurring in the workplace (i.e., naturalexperiments) to protect the well-being of workers.

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Chapter 4

For example, work-life programs and familyfriendly policies such as flexitime and flexiplaceare becoming increasingly common in the modernworkplace, presenting opportunities for researchto investigate effects of these types of interven-tions on worker safety and health. This type of re-search may be more properly called program evalu-ation.

Finally, increased research attention needs tobe given to the effects of legislation and publicpolicy that influences the organization of work. Oneexample of such legislation is the Family MedicalLeave Act (FMLA), which ensures the right forleave time for critical family medical reasons. Itcan be anticipated that the FMLA would reducestress associated with added workload burdens, jobinsecurity, or work-family conflict that may other-wise result from the need to provide family medi-cal care. However, empirical study of the FMLAor other social policy impacting the workplace isscarce.

All these types of intervention studies shouldinclude effectiveness measures for a wide range ofcost factors such as illness, injury and disabilityrates, health care utilization, absenteeism and losttime, etc., in addition to measures of health andwell-being that are more commonly collected inresearch on the organization of work (e.g., self-reports of health status, job satisfaction). Suchmeasures will help to better understand the inter-vention impact on injury and disease burden sus-tained both by workers and the organization.

Along this line, a new concept of organizationaleffectiveness (sometimes dubbed “organizationalhealth”) links organizational practices that pro-tect worker safety and health with high levels oforganizational functioning—a variant on thetheme “safety pays”. Safety and health studies of

organizational interventions that examine a broadrange of organizational outcomes may identify prac-tices that are conducive to both improved workersafety and health and improved organizational ef-fectiveness, thereby building a stronger case forworker protection through job redesign.

As a practical matter, advances in organizationof work intervention research would benefit fromimproved resources and training. A need exists fordeveloping and compiling information about thescience of intervention research, and for increasedexposure of researchers to this information in theirgraduate training to improve their capacity for in-tervention research. In this regard, it is notable thatthe topic of intervention effectiveness has beenrecognized as a research priority under NORA, anda team of specialists from NIOSH and outside in-terest groups have undertaken an evaluation ofknowledge on this topic similar to the present ex-ercise for organization of work [Goldenhar et al.2001].

Improvements in InterventionResearch Methods

Advances in knowledge of organizational inter-ventions to protect worker safety and health willrequire improvements in intervention researchpractices. There are two major issues here. First, aneed exists for improved guidance, and possibly anew paradigm, for designing and conducting re-search on organizational interventions. Stated in

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Intervention Research

Advances in knowledge of organizationalinterventions to protect worker safety andhealth will require improvements in interven-tion research practices.

the most general terms, approaches need to be ar-ticulated that build on the strengths and minimizethe limitations of various contrasting methods (e.g.,case studies and action research versus experimen-tal designs, qualitative versus quantitative meth-ods) and allow for expeditious conduct of inter-ventions in an organizational context. Respondingto this need, Zwerling et al. [1997] suggested thata sensible and economical approach to conductingintervention effectiveness studies begins withqualitative methods and quasi-experimental de-signs to explore the feasibility of interventions,holding randomized controlled trials in reserve fortesting and validating the most promising ap-proaches.

Second, intervention research needs to be moretheory driven to learn why and under what cir-cumstances organization of work interventions suc-ceed. In their recent report, the NORA interven-tion effectiveness team noted that too often inves-tigators do not adequately describe the interven-tion or address the issue of why or how an inter-vention is expected to bring about improvementin the safety and health of workers [Goldenhar etal. 2001]. Well designed, theory-driven interven-tion research increases the likelihood that an in-tervention will ultimately be effective because itleads to a better understanding of how the inter-vention works and allows for generalization andtailoring of the intervention to multiple situations.

Until recently, theory-driven models for occu-pational safety and health interventions were notcommon in the published literature. However,Cohen et al. [1997] developed a model for reduc-ing work-related musculoskeletal disorders thatprescribed a seven-step process beginning withproblem identification and leading ultimately tothe design of new work practices (intervention).

Melhorn et al. [1999] used this model to establishan occupational intervention program for muscu-loskeletal disorders and reported substantial sav-ings in worker compensation costs. Israel et al.[1996] presented a conceptual framework for in-terventions to reduce stress at work that was basedon a comprehensive model of stress and health.Such models provide guidance for each step in theintervention process (design, implementation, andevaluation). As a side note, both of the above-men-tioned models emphasize the need for managementcommitment and employee involvement in theintervention design process.

Implementing Interventions

More information is needed about critical fac-tors and conditions that motivate organization ofwork interventions to protect worker safety andhealth. Experience suggests that decisions for or-ganizational change are often driven by industryopinion leaders, by authority figures in organiza-tions who are convinced about the efficacy of neworganizational practices, by best practices, or byindustry norms (benchmarking). However, thesedecision processes are not well understood or ap-preciated in the scientific community.

Ethnographic study of organizations to betterunderstand the processes that govern interventiondecisions could lead to development of products

22

Chapter 4

More information is needed about criticalfactors and conditions that motivate organiza-tion of work interventions to protect workersafety and health.

to help motivate and support interventions. Ex-amples of these products might include (1) case-books on successful interventions to help organi-zations select, guide, and evaluate interventions;(2) design and promulgation of best practices basedon accumulated findings from intervention re-search; and (3) forums on organization of work and

health that are keyed to practitioners (in contrastto researchers) and highlight information aboutinterventions and intervention effectiveness. Studyof these decision processes could also lead to im-proved designs for intervention research (e.g., helpto identify organizationally relevant measures ofintervention effectiveness).

23

Intervention Research

5 Challenges ConfrontingResearch Progress

In 1965, the National Advisory EnvironmentalHealth Committee issued a landmark report to theSurgeon General of the U.S. Public Health Ser-vice that foresaw many of the changes in the orga-nization of work that are at the center of attentionin the present discussion: new work processes, thegrowth in alternative employment relationships,increasing participation of women and ethnic andracial minorities in the workforce, etc. [DHEW1966]. The report expressed apprehension thatthese changes posed new and unexplored threatsto worker safety and health and singled out psy-chological stress as a special concern. However,three decades have passed and many of these is-sues still await systematic investigation. What cir-cumstances have stood in the way of more aggres-sive study of the safety and health consequencesof the changing organization of work?

To begin with, the subject of organization ofwork and health has yet to become a cohesive fieldof study. Numerous disciplines have contributedresearch on this topic, including labor studies, eco-nomics, organizational behavior, public and occu-pational health, and the job stress field. Presently,little interface exists among these disciplines, anddifferences exist in methods and endpoints ofstudy. Historically, for example, the job stress fieldhas looked at individual and job characteristics inrelation to individual-level measures of health (e.g.,illness symptoms), whereas economic and organi-zational behavior research has focused more onorganizational parameters in relation to productivity

and other measures of organizational effectiveness.For these reasons, knowledge of occupational safetyand health effects of the changing organization ofwork is often fragmented.

Further, perhaps in part because organizationof work and health is not yet an established orwidely recognized field of study, research in thisfield has not enjoyed the funding opportunitiesafforded to more traditional topics in occupationalsafety and health. Also, it seems that progress hassuffered from too little interchange between theresearch community and the labor and businesscommunities. As a result, researchers are often slowto recognize changing conditions of work and therisks they may pose, and research opportunities andaccess to study sites and populations are often un-available.

Progress toward understanding and preventingsafety and health risks posed by organization ofwork factors requires a much stronger public healthcommitment to nurturing this field of study. Thetopic of organization of work needs to be elevatedto a higher level of visibility in the occupationalsafety and health field, and increased commitment

24

Progress toward understanding and preventingsafety and health risks posed by organizationof work factors requires a much stronger publichealth commitment to nurturing this field ofstudy.

to funding for this type of research is needed. Stra-tegic alliances among stakeholder organizations(Federal agencies, industrial and labor coalitions,professional societies, and academic researchers)will be essential to leverage these outcomes. Suchalliances will also facilitate research by enablingaccess to study populations, data sources, and in-kind support for research.

Equally important, steps need to be takenwithin the academic community and professionalorganizations to nurture and formalize the subjectof organization of work and health as a distinct fieldof study, and to provide the multidisciplinarytraining to ensure that students are prepared forresearch on organization of work and health. Such

training would combine methods and content fromthe fields of occupational health, epidemiology,psychology, management, industrial relations, andother relevant disciplines. Supporting this trainingneed, the Institute of Medicine [2000] has recentlyissued a recommendation for increased training ofoccupational safety and health professionals in theorganization of work (see Sauter and Hurrell[1999] for descriptions of prototype training pro-grams of this nature).

Satisfaction of these needs for recognition, re-sources, and capacity building stands as an impor-tant prerequisite for research to narrow the gap inunderstanding ways to protect safety and health intoday’s rapidly evolving workplace.

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Challenges Confronting Research Progress

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