By Robert Stuthridge, BSc, MSc, FRSH
Published in the February 2007 issue of Today’s Facility Manager
It is well known that, compared with industrial occupations, office work is relatively safe. Musculoskeletal problems like back pain and carpal tunnel syndrome (CTS) occur in significantly higher proportions amongst industrial workers compared with their desk based counterparts.
However, two interacting trends are of considerable significance for facility managers engaged in creating functional, efficient, and cost-effective office workplaces. The first is the steady decline in the U.S. manufacturing base from the late 1990s to date, which has caused a shift in labor from factory to office. This trend, according to a Congressional Budget Office report of February 20041, is unlikely to be reversed in the long term. The second trend is the graying workforce, which is a corollary of the aging U.S. demographic. This pattern will continue as the Baby Boomers get older and the influx of new white collar workers declines.
The migration of labor from industry to administration and service jobs means that many new office employees bring with them a mixture of pre-existing injuries (treated more or less successfully) along with premature wear and tear (undetectable by any current occupational health screening process). Either one of these tendencies has the potential to affect their ability to work comfortably, safely, and efficiently even in a fairly innocuous environment.
An Issue Of Age
Despite the logic and reality of the transformation of the workforce, it is quite rare for businesses to address the impact of employee age on workplace design. According to the MetLife Employee Benefits Trend Study of 2005/2006, 34% of all American employers and 46% of those with 25,000 or more workers agree that an aging workforce will significantly impact their company. However, less than 21% of these businesses have taken any steps to accommodate older workers.
Unfortunately, the most prevalent and costly of work related disorders—musculoskeletal disorders (MSDs) of the back, neck and upper limbs—not only have task design, but also age, as significant risk factors. This means the office worker in 2007 is more likely than ever to be at risk of an injury that has the potential to affect efficiency, productivity and employment costs.
For organizations seeking to control operating costs, the anticipation and efficient accommodation of older workers will become the only viable course of action if the twin costs of occupational health provision and health insurance premiums are ever to be controlled.
Age And The ADA
Before incorporating ways in which offices might be made more inclusive of injured and aging workers, it is essential for facility managers to understand the complexities of one additional matter: the Americans with Disabilities Act (ADA). Anti-discrimination legislation is never to be taken lightly. In times when there is scant loyalty between employer and employees, infractions of the ADA are unlikely to be ignored.
This issue is complicated by the fact that not all disabilities are obvious. Persistent cultural stereotypes of disabilities often involve wheelchairs, white canes, hearing aids and prosthetic limbs. These forms of disabilities exist, but they merely represent the tip of the iceberg when viewed from a definitional, legal, and practical perspective.
The submerged bulk of disability, far more extensive than these stereotypes, pervades the spirit and letter of the ADA and includes several disorders associated with an aging workforce. It is to the ADA’s concept of disabled that facility managers must subscribe to in order to steer the organization and its workforce clear of problems.
Definition Of Disability
By defining disability in terms of the impact of an impairment on non-work activities, it is likely that an employer may be unaware that a particular employee is disabled according to the language of the ADA. The ADA defines people who are disabled as:
- having a physical or mental impairment that substantially limits one or more of the major life activities of such an individual (such as eating, dressing, toileting, bathing, personal grooming, and regular household chores);
- having a record of such an impairment; or
- being regarded as having such an impairment.2
Considering the nature of these activities, it is clear that common work-related musculoskeletal disorders (WMSD) like back and neck problems, osteoporosis, upper limb problems (e.g. CTS) and osteoarthritis can have an adverse impact on functionality. For this reason, people with these types of disorders—particularly if severe or chronic—might be classified as disabled.
The obligation to make reasonable adjustments to accommodate the needs of people with such disabilities rests with the employer, even if the measures used to determine disabled status are, for example, the capacity to carry a 10 pound bag of groceries, chop vegetables, bathe, wash clothes, lift a saucepan, or open a jar.
The potential scale of disability is immense. In 1990, the ADA indicated that 43 million Americans were disabled. Furthermore, this number increases with an aging workforce. Americans With Disabilities 2002 numbered disabled people at 51.2 million, 32.5 million of whom were severely disabled.3
Dealing With WMSD
Since WMSD are not only highly prevalent but also steady in incidence4, employers must face the inevitable. By accepting WMSD as potential disabilities, facility professionals will be compelled to consider “inclusive” workplace design in order to control facilities operating costs.
As the population ages, employers will encounter more disablement. Disablement occurs when the design of the built environment does not accommodate individual capacities, whether these are age-related or tied to more stereotypical impairments. Unfortunately, many workplace designers continue to create working environments which assume unimpaired functionality and youthful workers.
With one in six workers now likely to have some level of disability, this increases the risk that equipment adaptation or substitution will become necessary to enable workers to operate without risk to health or efficiency. This may mean something as simple as replacing standard task chairs with premium priced specialist ones for workers who suffer from back pain. It could also translate into something far more complex and expensive.
Relying on post hoc interventions is costly, since this entails additional purchases, redundancy of serviceable equipment, delays in restoring efficiency to affected workers, and increased risk of injury, absence, and lawsuit. The facilities manager, needing routinely to accommodate a growing number of disabled workers, must evaluate the inclusiveness of every component of the workplace.
The New Normal
Before effective design evaluation can take place, it is essential to adjust the concept of what is considering “normal,” specifically with respect to the working population. By meeting the functional needs of the current worker (as previously defined by age, demographic, and physical condition), demands made on the capacities of others should not be excessive. This underlies the principle of inclusive design, in which the needs of the least functional person set the standard by which an approach is judged.
With an inclusive eye, the facility manager looks at workplaces more critically. The result of the critical analysis process is a workspace that accommodates the highest percentage of workers, increasing efficiency while reducing risk of injuries and their associated costs.
For example, critically evaluating the inclusiveness of a sit-stand table might involve asking if it is easy to use by someone with arthritis and whether there is a more usable design available. If vertical force is required to elevate or lower a sit-stand table, is this safely manageable by a worker with lower back problems?
Inclusive Design Plans
There are indeed many questions that should be systematically addressed before purchasing furniture, selecting equipment, or agreeing to an architectural design for a building. If the facility manager initially needs help, ergonomists with appropriate expertise are available.
The aim is to construct an Inclusive Design Plan (IDP) that will inform and shape future furniture and equipment selection decisions. The goal of an IDP is to reduce redundancy, redesign, and replacement.
The following pointers should be considered in order to make office workstations more inclusive. This combined solution generally eliminates the need for reactive intervention and should save money on remedial or disused equipment.
Work Tables. Shape should be rectangular, with straight, not curved edges. Workstations should allow postural variation, including the choice of standing or sitting to work, without inducing awkward postures.5
Intermittent sitting and standing reduces the risk of low back pain. A work surface height range from 23″ to 48″ would accommodate over 90% of U.S. adults, including those using wheelchairs.
Height adjustment should be electrically powered (eliminating manual handling risk), incorporating controls that are accessible and operable with minimal force. Central support pillars create leg space problems, so twin leg designs are preferred.
The incorporation of slim LCD display screens—especially arm mounted—enables the use of compact tables. Smaller tables free up more space between workstations for wheelchair access, but the work surface must still comfortably accommodate all tasks performed there.
It is not a good alternative to provide static tables fitted with adjustable keyboard/mouse platforms. Such platforms cause more problems than they solve and produce awkward postures for untrained typists (the majority of workers) when viewing the keyboard at low heights. They also reduce under desk clearance when the platform is stowed away, increase reach distances to the workstation when the platform is extended, and the lack of space for a document holder make keyboard/mouse platforms relatively poor in terms of ergonomics (despite claims made by makers and supported by flawed laboratory research). Problems created by platforms are even greater for many wheelchair users, so money saved here might be used on a powered workstation, better task chair, or risk reduction training programs.
Work Chairs. Chairs should accommodate and support the largest percentage of users in terms of seat height, seat depth, seat width, backrest length, backrest width, armrest height, width, and depth. From an inclusiveness standpoint, it is generally better to avoid synchronous seat/backrest angle adjustment mechanisms, which use predetermined ratios of pelvic angle, in favor of the independent adjustment of seat and backrest angle.
A recently commissioned survey of ergonomic task seating revealed that price is not a predictor of ergonomic performance. Several “high end” models offered inadequate support to potential users, while less expensive models afforded higher levels of fit and support.
Footrests. Well designed footrests feature a suitably large, totally flat non-slip support platform that may be locked at a specific height and angle. A footrest with this feature affords support to the entire underside of the feet.
Footrests not only allow employees to fine-tune sitting heights for optimum upper limb working postures, but they also encourage reclined trunk postures. Such postures are beneficial, particularly for back pain sufferers, provided that workstation layout is appropriately configured. Upright sitting is, of course, unhealthy.6, 7, 8
Document Holders. These devices must securely support reference documents, including heavy files and books, when used. The document holder should be located immediately behind the keyboard, centered to both keyboard and monitor. Only here is it safely viewed and reached.
Telephone Headsets. Considering costs only, cordless telephone headsets are the way to go. However, even corded headsets are a worthwhile investment to eliminate the appalling practice of cradling the handset between shoulder and ear. This contorted position increases the risk of neck, back, shoulder, and upper limb disorders.
Cordless headsets should be purchased for anyone who might need to speak on the telephone and either handwrite or access their computer at the same time. Headsets have no real downside or detraction.
Monitor Arms. Designs that allow rapid variation in distance to the user as well as viewing height and angle are the most useful. These generally feature an arm that has two or more sections, with elbow joints enabling the display to be moved in a straight line to or from the viewer.
Facility managers should ignore suggestions of arm’s length when determining screen distances; these are erroneous. Comfortable visual distance is a function of many factors, including user preference, displayed image size and clarity, level of concentration required for the task, perception of pressure to complete the task correctly or quickly, ambient distractions, and so on.
Viewing heights may be affected by the use of variable focus spectacles, with some users preferring lower viewing heights when using this type of eye wear. Clamp-on units (rather than through the top, pre-fitted units) are preferred, as they enable alteration of display location to suit each user.
Task Lamps. General lighting may not meet the needs of older workers or those who have some degree of visual impairment. Freestanding adjustable task lamps are invaluable. Wherever possible, designs should incorporate adjustable output levels and offer the option of daylight bulbs or colored filters (which can assist with some forms of dyslexia and epilepsy). Adequate task lighting may be helpful in reducing fatigue and therefore affect performance in a positive way. Gloomy working conditions may increase awkward neck and trunk postures and may prove especially troublesome for untrained typists working with black or dark-colored keyboards. Rigid compliance with task luminance guidelines is unhelpful if these do not accommodate individual workers’ visual requirements.
The Changing Dynamic
These product recommendations will not eliminate health and efficiency problems attributable to poor work patterns, control over which is generally outside of the remit of facilities managers. Many professionals are constantly engaged in replacing or adapting existing designs to suit changing workforce requirements. Under these conditions, there is far more pressure to incorporate short-term solutions—both in terms of time and money. But in some situations, facility managers who have anticipated the increasing needs of the workforce will be granted the luxury of applying their expertise to other, more constructive projects.
It is hoped that facilities managers, fully aware of population trends, will adopt clear, inclusive design strategies that both predict and match the capabilities and capacities of the “new normal.”
Stuthridge is a senior health ergonomist with Integrated Ergonomics LLC in Indiana. He is a Fellow of the Royal Society for the Promotion of Health and a member of the Human Factors and Ergonomics Society.
Other posts by