Proceedings of NES2011. September 18 21, 2011 Oulu, Finland

Size: px
Start display at page:

Download "Proceedings of NES2011. September 18 21, 2011 Oulu, Finland"

Transcription

1 Proceedings of NES2011 September 18 21, 2011 Oulu, Finland

2 Edited by: Juha Lindfors Merja Savolainen, Seppo Väyrynen ISBN (USB) 6

3 PREFACE The 43 rd Annual Conference of the Nordic Ergonomics Society rotates among the Nordic countries, and in 2011 the Finnish Ergonomics Society will host the NES2011 conference in Oulu, the technological Capital of Northern Finland on September The NES2011 conference is jointly organized by the University of Oulu, Finnish Institute of Occupational Health, the Oulu University of Applied Sciences, University of Eastern Finland, and University of Lapland. The aim of the NES2011 conference is to bring together researchers and practitioners with an interest in ergonomics. This facilitates the sharing of results and contributes to the foundation of networks as well as improving the quality of ergonomics. Despite of the Nordic dimension the conference invites participants from all over the world to join this hearty and contemporary conference. The theme of the conference is Wellbeing and Innovations Through Ergonomics. Besides of the keynotes given by experienced and well known ergonomists the scientific sessions contains such topics as Management and development for sustainability, Cognitive ergonomics and human factors, Visual ergonomics, physical ergonomics, Social and health care, Promotion of health and wellbeing at work, Cognitive ergonomics and human factors, Human factors in product and service development and Organisational ergonomics, Designing and organizing for all, Safety critical systems and environments, and Ergonomics in transport. Moreover, the conference includes method and OH&S workshops and several poster presentations. During the conference the NES, Nordic supervisors related to national occupational and safety affairs, and visual ergonomics network have their annual meetings. This proceeding is the collection of the 98 scientific papers accepted to be published and presented at the conference. The papers are listed in the order of appearance in the conference itself. The editors wish that this publication was a useful tool for those participated in the NES2011 conference. We also hope that some researchers outside the Nordic ergonomics community find this edition useful with its very extensive scientific and practical content. We as the editors would like to express our sincere thanks to all authors and all those who made the NES2011 a successful international academic and professional event. Editors Juha Lindfors Merja Savolainen Seppo Väyrynen 7

4 KEYNOTES Stakeholder-oriented Management Concepts as Challenge for Macro-Ergonomics - How can macroergonomics successfully contribute to quality and sustainability? Klaus j. Zink Over, under, optimal: how to manage with cognitive load? Kiti Műller Management with wellbeing and ergonomics - the mission impossible? Jari Stenvall Visions of ergonomics for globally operating business. John Abeysekera User experience as a challenge for cognitive psychology and ergonomics. José J. Cañas Participative development - production and ergonomics. Mikael Forsman 8

5 STAKEHOLDER-ORIENTED MANAGEMENT CONCEPTS AS CHALLENGE FOR MACRO-ERGONOMICS HOW CAN MACRO-ERGONOMICS SUCCESSFULLY CONTRIBUTE TO QUALITY AND SUSTAINABILITY? Zink, K J Chair for Human Factors and Industrial Management, Institute for Technology and Work, University of Kaiserslautern P.O. Box 3049, Kaiserslautern, Germany The goals of ergonomics and macro-ergonomics have been traditionally connected with human well being and productivity or efficiency. In a sense this was mostly a duality between people and company goals. Otherwise within the IEA and HFES Technical Group macro-ergonomics broader concepts like Total Quality Management (TQM) are discussed. In recent times the concept of sustainability also attracted more interest within ergonomics. To make a real progress regarding quality and sustainability old and new approaches of human factors in organizational design and management now described as macro-ergonomics are needed. The paper will show how macroergonomics can successfully contribute to quality and sustainability. Keywords: Macro-ergonomics, quality, sustainability 1. Introduction During the last years the world of business was dominated by a wrongly understood concept: the shareholder value. In contrary to the founder of this concept, Alfred Rappaport ( 1998), who was interested in improving the shareholder-value of a company in a mid- or long-time perspective, the financial analysts at the stock-exchanges focused on short-term results which led to a wrong and short-term oriented behavior of managers. As results downsizing with lay-offs, suppression of suppliers or reduced investments in R&D could be recognized. A growing number of people criticized this policy because of its danger for securing the future of the companies. This led to an increasing discussion about the necessity to focus on all stakeholders instead of only the shareholder. In this context stakeholder-oriented management concepts gained more and more importance. Therefore, first of all the terms stakeholder and management concept have to be defined. Starting with Freeman, one of the basic sources in strategic management, stakeholders are defined as individuals or groups which depend on the company for the realization of their personal goals and on whom the company is dependent. (Freeman 1984, p. 13) Or from a risk management perspective: Those groups without whose support the organization would cease to exist. (Freeman 1984, p. 31) An even broader definition based on the re-definition of the corporation with a stakeholder-focus formulated Post et al 2002: The stakeholder in a corporation are the individuals and constituencies that contribute, either voluntarily or involuntarily, to its wealth-creating capacity and activities, and therefore its potential beneficiaries and/or risk bearers. (Post et al 2000, p. 17) If we look at relevant stakeholder for ergonomics customers, employees, shareholders or company owners and society could be named in a first approach. Later in the paper these stakeholders will be discussed again. Why is it important to integrate macro-ergonomics in a management concept? The 9

6 answer is given by looking at the main pre-conditions for a management concept: It should be or have: a systematic approach with defined feedback control systems instead of isolated activities, embodied in corporate strategy to show the relevance of the topic, top management support to secure the contribution to competitiveness, appropriate organizational structures to incorporate the feedback systems, a learning concept being able to be further developed, a stakeholder-orientation and securing effectiveness as well as efficiency. (Bleicher 2004, p. 361ff) The relevant management concepts in this context are Total Quality Management and Sustainability respectively Sustainable Development. The specific relevance for the further discussion can be seen in the stakeholder-orientation of both approaches. An old, but no longer valid ISO definition of Total Quality Management reads as follows: Management approach of an organization, centered on quality, based on the participation of all its members and aiming at long-term success through customer satisfaction, and benefits to all members of the organization and society. If we go back to the above definition of the stakeholders of ergonomics we can see the coincidence. The same picture is given, if we analyze international business or organizational excellence concept like the EFQM Model for Excellence having the same set of stakeholders. (EFQM 2009) As both approaches are based on a stakeholder conception, in the following the discussion shall be reduced to sustainability. 2. Sustainability and Corporate Sustainability Before discussing sustainability in the context of macro-ergonomics the history and term of sustainability has to be clarified: Sustainability is an old economic principle coming from forestry in the Middle Ages, when timber served as a main source for several economic processes (e.g. as energy source, building material etc.). The growth of population led to excessive overuse and clearings causing an economic and ecological crisis. As a consequence forestry anchored different regulations of felling and systematic afforestation balancing the regeneration of timber resources and their use (Nutzinger 1995). Sustainable forestry shows that sustainability is a primal economic principle and is finally necessary for the long-term survival of societies. Of course, our modern understanding of sustainability is much more complex than the example of forestry in the Middle Ages. Sustainability or sustainable development (as a process) is characterized by the normative claim for intra- and intergenerational fairness as it was stated in the well-known definition of sustainable development by the WCED in It further means the concurrent combination of economic, ecological and social goals: Therefore one can also describe it as a three pillar model (UNCED 1992). Transferring this general definition on a corporate level leads to the concepts of corporate sustainability or corporate social responsibility, coming along with the following definition elements (Dyllick and Hockerts 2002): Not only economic but also social and environmental prerequisites and impacts as well as the interdependencies between them have to be taken into account. Corporate sustainability requires a long-term business orientation as a basis for satisfying stakeholders' needs now and in the future. The rule to live on the income from capital, not the capital itself has to be applied for all kinds of capital: financial, natural, human, and social capital. Stakeholder orientation and Corporate Social Responsibility are similar concepts. 10

7 3. Sustainable work systems As human factors is dealing (among others) with work systems it might be helpful to look at the current discussion about sustainable work systems (Docherty et al. 2009): It is not surprising that again the concurrent development of economic, ecological, human, and social resources engaged in work processes is the main goal. Therefore sustainable work systems have to be able to function in their environment and to achieve economic or operational goals, while there is also a development in various human and social resources engaged in their operations. Employees capacity to deal with new demands in this context grows through concepts of work-based learning, development, and well-being. The growth of social resources is secured through equal and open interaction among various stakeholders, leading to better mutual understanding and a greater capacity for collaboration. The diversity and regeneration of ecological resources is safeguarded as well. There is no simple satisfaction of certain needs of certain stakeholders, but the need to satisfy the needs of many stakeholders. Here again the focus should not be only on short-term, static efficiencies, like productivity and profitability, but also on long-term, dynamic efficiencies like learning and innovation. There are no simple trade-offs between short-term and long-term goals or between different stakeholders, but there is a need for a just balance in development for them all. One important task is to bring the (often more short-term) requirements of competitiveness and those representing a long-term sustainability together. Sustainable work systems aim to regenerate all resources utilized. The development of one type of resource does not exploit resources of other types. And a sustainable work system does not build its existence on the exploitation of external resources. 4. Human Factors and Sustainable Work Systems If we now ask, whether this understanding of sustainability is already a part of human factors thinking, we can conclude that theoretically all three pillars are included in traditional ergonomics approaches as the following examples show: The design of work processes is realized under time aspects (productivity; economic goals) Job satisfaction and personal growth are also goals for job design (social goals), and environmental aspects like noise or pollution are considered in the design of work systems (ecological goals) But there are also some questions: Do human factors call for a concurrent realization of all three dimensions of sustainability? Do we not exploit external resources (e.g. in international value creation chains)? How do we deal with changed frame conditions like short-term orientation, work intensification, permanent change? If we really want to design sustainable work systems which fulfill the demands of a comprehensive quality management there is a need e.g. for: a systemic and holistic approach regarding whole value creation chains a systemic and holistic approach regarding the impacts on society (e.g. because only people and groups who operate sustainably are able to grasp, prioritize, and work toward ecological sustainability) a life-cycle-perspective regarding product (and work systems) design more complex tools for understanding what a sustainable work systems is and how it functions 11

8 5. The relevance of a macro-ergonomics approach How can we solve these new demands for human factors? As described above this is only possible with a systemic and holistic approach, which is given by macro-ergonomics. The early definition of macro-ergonomics by Hendrick (2002, p. 3) includes a socio-technical systems approach which could be a first basis to solve the problems concerned with sustainable work systems. Taking an even broader approach by understanding macro-ergonomics as a stakeholder-oriented human systems interface-design (Zink 2002), including a socio-technological systems approach (Zink 1999), one can specify the contribution of (macro-)ergonomics to the above discussed stakeholders: (Zink, 2002, p. 355ff) 5.1 (Macro-)Ergonomics and Customers In a world of global competitiveness products are more or less similar. Therefore, a competitive advantage can be gained by including ergonomic knowledge in product development as seen in Kansei Engineering (Nagamachi, M. 1994) and the growing field of usability engineering. There could be more progress in the future in combining ergonomics and ecology in product design, including aspects of sustainability based on innovative technology and economic problem solving. (GfA 2000) That means to understand ergonomic design concepts as part of holistic approaches to create products different from others and therefore with a competitive advantage. One important step could be to have a quality assurance of using ergonomics in industry by certifying the quality of use for ergonomic tools and procedures in the product development and manufacturing process and giving the customer the security that he or she is buying a product that includes all the ergonomic knowledge available at the moment. The International Ergonomics Society is developing such a concept. (International Ergonomics Association 2005a) 5.2 (Macro-)Ergonomics and Employees This topic is not really a new one but again from a marketing point of view it could be replaced by concepts of health management (e.g. Zink 2005) in a frame of corporate social responsibility (as basis for socially responsible investments (e.g. Zink 2003) or as an instrument for improving the sustainability of human or intellectual capital. (e.g. Stewart 1997) Another very important approach is focusing on change management as an important element of Macro-Ergonomics. As experiences show, only a socio-technological change approach will be successful (e.g. Zink, K.J. 2000) and keep jobs for the employees. 5.3 (Macro-)Ergonomics and Shareholders As mentioned above the instruments of macro-ergonomics include the chance for win-win situations between a company and its employees. (e.g. Zink 2006) The ideas of continuous improvement also as part of Total Quality Management contribute to better financial results. (e.g. Zink 1997) A holistic approach of change management may be a precondition for survival. Here again employee participation and a socio-technological systems approach can only be delivered by specialists in macro-ergonomics. Customer oriented products will contribute to an enlargement of market shares, if being part of a broader design concept with a respective quality assurance. All these activities will also lead to an increased shareholder value. 5.4 (Macro-)Ergonomics and Society Looking at the consequences ergonomics can create for society, we will at first find some traditional positive results (Zink 2002), coming from concepts like occupational health and safety, security of complex systems, like traffic or power plants, integrative health management systems or community ergonomics. But there have also been some negative aspects in the past which should challenge (macro-)ergonomics for additional concepts in the future. 12

9 6. Summary and Outlook Especially the negative aspects of a wrongly understood shareholder-value concept enlarge the awareness for stakeholder-oriented management concepts. Customers, employees, shareholders or company owners and society can be characterized as primary stakeholders. This stakeholder orientation can also be found in the approaches of Total Quality Management and Sustainability as well as (macro-)ergonomics. Looking at the demands for designing sustainable work systems macro-ergonomics is able to deliver respective solutions. References Bleicher, K Das Konzept Integriertes Management. 7. Aufl., Frankfurt: Campus. Docherty P., Kira M. & Shani A. B. (eds.) Creating Sustainable Work Systems, Second Edition, London and New York: Routledge Dyllick T. & Hockerts K Beyond the Business Case for Corporate Sustainability. Business Strategy and the Environment, 11, EFQM (Ed.) The EFQM-Model for Excellence Brussels: EFQM. Freeman, R.E Strategic Management A Stakeholder Approach. Boston: Pitman. Gesellschaft für Arbeitswissenschaft (GfA) Die Zukunft der Arbeit erforschen: Ein Memorandum der GfA zum Strukturwandel der Arbeit [Research for the future of work: a memorandum of GfA related to the change of work]. Dortmund: GfA Press. Hendrick, H. W An Overview of Macroergonomics. In Hendrick, H. W. & Kleiner, B. M. Macroergonomics: Theory, Methods, and Applications. Mahwah, NJ & London: Lawrence Erlenbaum Ass. International Ergonomics Association (2011). EQUID [Ergonomics Quality in Design] Activities. =equid_committee. Accessed 10 August Kennedy, A. A. (2000), The end of Shareholder Value, Cambridge/MA: Perseus Publishing. Nagamachi, N. (1994). Kansei Engineering: A consumer oriented technology. In G.E. Bradley & H.W. Nutzinger H. G Von der Durchflußwirtschaft zur Nachhaltigkeit Zur Nutzung endlicher Ressourcen in der Zeit. In Biervert, B. &, Held, M. (eds) Zeit in der Ökonomik: Perspektiven für die Theorienbildung. Frankfurt: Campus, Post, J. E., Preston, L. E. & Sachs, S Redefining the corporation Stakeholder Management and Organizational Wealth. Stanford, CA: Stanford University Press. Rappaport, A Creating shareholder value: a guide for manager and investors. 2nd ed., Florence/MA: The Free Press. Stewart, Th. E Intellectual Capital: The New Wealth of Organizations. New York et al: Doubleday/Currency. UNCED (United Nations Conference on Environment and Development) Rio Declaration on Environment and Development. Rio de Janeiro. WCED (World Commission on Environment and Development) Our common future. Oxford: Oxford University Press. Zink, K. J Total Quality management as Holistic Management Concept: the European Model for Business Excellence. Berlin: Springer. Zink, K. J Safety and Quality Issues as Part of a Holistic (i.e. Sociotechnological) Approach. International Journal of Occupational Safety and Ergonomics (JOSE), 5, 2, Zink K. J Ergonomics in the past and the future: from a German perspective to an International one. Ergonomics, 43, 7,

10 Zink, K. J A Vision of the Future of Macroergonomics. In Hendrick, H. W. & Kleiner, B. M Macroergonomics: Theory, Methods, and Applications. Mahwah, NJ & London: Lawrence Erlenbaum Ass., Zink, K. J Corporate Social Responsibility Promoting Ergonomics. In Luczak, H. & Zink, K. J. (Eds.) Human Factors in Organizational Design and Management VII- Re-Designing Work and Macroergonomics Future Perspectives and Challenges. Aachen/Santa Monica: IEA Press, Zink, K. J. 2005a. From Industrial Safety to Health Management. Ergonomics, 48, 5, Zink, K. J. 2005b. The Future of Organizational Design and Management (or Macroergonomics). In Carayon, P., Robertson, M.; Kleiner, B.; Honakker & P. L. T. (Eds.) Human Factors and Organizational Design and Management VIII, Proceedings. Santa Monica: IEA Press, pp Zink, K. J Human Factors, management and society. Theoretical Issues in Ergonomics Science, 7, 7,

11 MANAGEMENT WITH WELLBEING AND ERGONOMICS - THE MISSION IMPOSSIBLE? Jari Stenvall Professor University of Lapland Finland Spaces, furnishing, and work equipment are all factors closely related to ergonomy and they have always had a marked symbolic role in administration. To give an example, the Finnish administrative historians Seppo Tiihonen and Heikki Ylikangas describe 17th century offices in their book Virka. Valta. Kulttuuri. They tell, for example, that naturally all civil servants office rooms had tables. But the size of the table varied according to the civil servant s status. The chambers of the president of a court of appeal would have a desk and a walnut tallboy, and a painting on the wall. The department and registrar s room would have single or double desks. Status also determined how the chair was padded, whether the chair had padded armrests, what kind of ink bottle he had, as well as the amount of lighting i.e. the number of candles available. In this presentation I will make a connection between well-being at work and ergonomy. The title has a question mark, certainly for a reason. In working life, plans are not made solely from the perspective of well-being at work and ergonomy. Work equipment and practices are affected by, for instance, culture, esteem, power relationship as well as the relations between actors as shown by the example I gave. My argument is that ergonomy, and all too often also well-being at work, play minor roles in working life. The question is actually how minor their roles are and would it be possible to make their roles a little more central. Ergonomics is not my field of research. My research background is in management and organizations, public governance in particular. I have also worked with various projects related to well-being at work and personnel issues, and I have, for instance, chaired the scientific specialist group of the Finnish Work Environment Fund that funds research into working life questions. How many of you here have a background in management or management research? I suppose few people interested in management are particularly in well versed in ergonomics. If we approach the question from the perspective of management literature, we can say that usually the advancement of well-being constitutes a part of management. On the other hand, questions related to ergonomy are rarely found in basic management instructions. It seems that the advancement of ergonomy is quite often primarily considered a task for specialists, and not something included in the everyday work of a manager. 15

12 Loosely interpreted, however, questions related to ergonomy, work equipment, as well as well-being at work, have a long tradition in management research. Frederick Taylor, who devised scientific management, paid attention to the use of appropriate tools already in the late 19 th century. He connected this particularly to the perspective of productivity. Correspondingly, the early steps in the development of well-being at work and social relations in management research can be traced back to the school of human relations that evolved in the early 20 th century. Among other things, it took up the importance of the concept of human, the community, and the functioning of interaction from the point of operations. Well-being, management, and ergonomy have found each other quite well in practical development work. A typical outline could be: Ergonomy is used for adapting work, tools, working environments, and the rest of the operating system to human properties and needs. Good ergonomy is used for improving human safety, health, and well-being, which contributes to undisturbed performance of work. I am not fully acquainted with the situation in other Nordic countries but at least in Finland several different projects have been funded with the aim to interconnect the perspectives of well-being and ergonomy. As I said, I am not actually a researcher of ergonomy but primarily of management. In the following I am trying to make a general evaluation of completed projects and the image they convey of the relation between ergonomy and well-being at work from the perspective of management in particular. First of all, I must say that although I consider efforts to promote well-being at work and investments in it essential and necessary, I think that effective measures to promote well-being at work have still remained undiscovered in research. In fact, we do not yet know enough how to promote well-being at work in an appropriate way. This is why it is understandable that it is also difficult within ergonomics to find such measures that would credibly contribute to well-being. Secondly, it is true that well-being and partly also ergonomy are often improved, i.e. managed, seemingly. This means that the implementation of these issues very often receives much less management energy than, for instance, the promotion of strategies or solving operational questions. From the perspective of management the problem with well-being at work and ergonomy is often credibility. The question is how profitable it actually is to promote well-being and related ergonomy. In management the cost/benefit perspective is often essential. Investments in well-being at work is undoubtedly beneficial (I am referring here to research by Guy Ahonen), but quite heavy research processes are needed before you can present any exact cost/benefit figures. Even if there were pilot studies on good practices to promote well-being at work and ergonomy, the problem is that they rarely spread from one organization to another, just like other best practices. Perhaps ergonomics specialists have been too idealistic. It is believed that good things will find their place in organizations. This is not the case if you want effective development of ergonomy, you must also understand the logic of the function and management of organizations. Thirdly, my argument is that projects that combine well-being at work and ergonomy, and partly management, are quite often concentrated on so-called safe businesses, such 16

13 as transport or forestry workers. These are important fields of business, but my hope is that the alliance of ergonomy, well-being, and management would also find workers in, for instance, creative jobs to a greater extent. Fourthly, ergonomy has often been studied with a rather narrow scope in conjunction to well-being at work. Well-being at work is fundamentally both physical and psychical in nature and emphasis on these dimensions varies in time and for each organization. In some cases, i.e. in organizations, it may be important at a certain point of time to pay attention to the physical conditions of working, while in other working communities the emphasis of development related to the working conditions are constantly dealing with psychical questions. The physical conditions of work are related to how the physical factors of work are arranged. In factory halls attention used to be paid to occupational safety (training in machine operation and minimization of risks of injury) and to other conditions, such as lighting and the length of breaks. My argument is that quite often the questions related to ergonomy are examined related to the physical conditions only. The contents of physical conditions have also changed, and I think this has not been sufficiently accounted for in projects concerning ergonomy. In addition to work ergonomy, the changes relate to such questions as workplace arrangements in office organizations (open-plan office, or traditional arrangement with walls separating working positions into individual rooms), lighting and occupational safety from the point of physical integrity (for instance, certain safety arrangements in banks and social welfare offices, etc.). The psychical conditions of working communities are in a way more difficult to observe than the above physical conditions. Psychical conditions relate to, for instance, what kind of spirit the workplace has, how urgently the work needs to be done (and how is urgency reflected in the stress levels of the workers), how meaningful is the work experienced, and how highly is the work of each individual esteemed. It is these kinds of psychical conditions that have over the past decades received increasing attention. In my opinion, questions of psychical well-being at work have received very little attention in conjunction to ergonomy, at least on the basis of the projects within which joint development work has been done concerning these issues. In addition to physical and psychical conditions there are a number of phenomena that have gained publicity over the past decades and that are actually rather difficult to categorize on the basis of the dichotomy of physical and psychical conditions discussed above. Sexual harassment is an apt example of this. Different forms of sexual harassment can be very subtle, and sexual harassment can also be experienced in a variety of different ways. If those versed in ergonomy genuinely want to affect wellbeing at work they should account for even such difficult phenomena as sexual harassment. Well-being at work is not a static term, and it is definitely not a static phenomen. This perspective arises in, for instance, Pauliina Marjala s fresh and also methodologically interesting dissertation Experiences on wellbeing at work as narrative processes a narrative evaluation study (Marjala 2009). According to her, wellbeing at work does not include just work but it is a phenomenon related to, for instance, the workers context of work, and the personal histories and life situations of individuals. Another significant and apparently self-evident observation is that well-being at work is no static status but changes constantly over the life-span of the individual. My argument is that very often, when trying to connect ergonomy with 17

14 well-being at work, a static and permanent concept of well-being at work has been adopted. I would like to suggest that you would try to come up with an answer to the question how we could make the promotion of ergonomy more dynamic and, for instance, the interactive development of workplaces more understanding. When I examine projects that combine questions of well-being at work and ergonomy, it is fairly easy to observe the shallowness of management expertise in them. Very rarely you will find perspectives according to which, for instance, information or quality management is developed in an organization, or activities based on positive psychology, with the aim of finding solutions through which well-being at work and ergonomy could be advanced. Specialists in ergonomy often seem not to master even the basic features the management of well-being at work. It should be pointed out, however, that the management of well-being at work in itself is already challenging. The manager must be able to be aware of his subordinates individual statuses of well-being at work, which are also constantly changing, not to mention that the manager shall identify the collective experience of well-being at work among his subordinates. This is a question of what is the prevailing feeling of well-being at work in the working community. At the same time, it is a question of the contents of management meeting the personnel s expectations of it. Well-being at work is actually both a condition for and a result of good management work. It is easier to manage a working community that experiences well-being than one with a poor spirit, where the objectives of work are considered unclear, and the conditions related to carrying out the work are deemed poor. The personnel s wellbeing at work is reflected in that the personnel have the energy and the will to participate in management tasks, such as strategy planning or the implementation of organizational change. On the other hand, well-being at work is a result of good management work. Central to activities promoting well-being at work is the fact that the management recognize the importance of well-being at work, master the development procedures related to well-being at work, and are able to prioritize them as necessary, as well as understand the effects of development procedures related to well-being at work. My presentation has been critical towards how ergonomy, management, and well-being at work are meeting. Dear researchers of ergonomy, my message could also be this: If the practical effects of ergonomy are important to you, make yourselves better acquainted with psychical and dynamic well-being at work, and especially with management. Another solution would be multi-disciplinary researcher and developer groups. Among other things, in projects promoting well-being at work it would be useful to be able to involve more specialists of various fields as well as those of well-being at work and management. Even from this perspective I want to express my thanks for having the possibility to give my presentation in this important conference. 18

15 VISIONS OF ERGONOMICS FOR GLOBALLY OPERATING BUSINESS NES 2011 John Abeysekera Work Science Academy, Sweden, Sri Lanka Branch, No.2 Nadurupitiya Road, Kandana, Sri Lanka Information revolution and world wide application of advanced technology have made ICs as well as IDCs to join the network of global business. Not only in production of goods and technology there is globalization in education, travel, economy, marketing, etc. The mad rush in the development process seems to have overlooked the essential ingredient viz. human factors, required to reap the intended benefits of operating global business. Not only the methodology (used in applications) but the knowledge of science and principles of ergonomics is a paramount need to operate global business successfully. This paper also illustrates that successful methodologies practiced by some global companies are in fact ergonomic methods. For comprehensive ergonomics which is a need to make ergonomics a world-wide concept, training and education in the science and principles of ergonomics is essential for the whole world. Keywords: Global business, Ergonomics, Technology transfer 1 Introduction The word Global has become almost a household word in the modern times. Several Industrialized Countries (ICs) and also Industrially Developing Countries (IDCs) have developed their technology, education, manufacturing, economy, marketing and a host of other activities to reach global proportions. These countries have adopted different methods and techniques to develop their businesses. ICs have advanced in technology step by step in a traditional way taking advantage of their rich economy and advanced educational systems. Some IDCs on the other hand have skipped the intermediate phases and copied the technology of the west (Abeysekera and Shahnavaz, 1987). Since 3/4 of the world s population live in IDCs it was necessary for the ICs to involve IDCs to globalize their business. The World Trade brought ICs and IDCs together which was boosted by modern transport systems, Trade Pacts, Bi-lateral Aid Programmes and Free Trading Policies. Further the exchange of modern technological, processes, methods, knowhow, production techniques, organizational management and maintenance procedures have all contributed to enhance global business. One major cause of globalization of business is the dawn of Information Technology. After the agricultural revolution and later industrial revolution a third wave of revolution has been the information revolution. Micro electronics has offered a way of storing, processing and communicating vast amount of information quickly and cheaply. It is however predicted that IT can have the following impacts. (Eason, 1992) - Paperless Offices - Unmanned Factories - Electronic Cottages - Collapse of the city - Global Villages - Demise of the Experts It is also predicted that the IT revolution will result in the disappearance of newspapers, 19

16 books, and postal communication, and city centers will become deserted and rush hours a thing of the past. While the world will become a collection of specialist networks, the experts will be redundant. It is important to consider how all these changes will have an impact on the human being. It is predicted that the information revolution can have a negative impact on man as the technology will lead to mass unemployment. The positive view however is that it will lead to a leisured society. There can also be a massive cost reduction in staff savings and space. Other benefits being improved productivity and improved and quick transmission and processing of information. It will also lead to organizational enhancement resulting in new business. (Eason 1992). The major aim of this paper is to highlight the need for considering the human factors which are neglected in the mad rush in operating global business. The causes of negative impacts and the neglect of human factors have to be identified and adequate measures taken to achieve the expected advantages in global businesses. 2 Globalization paths of ICs and IDCs Different methods and paths have been adopted by companies in ICs and IDCs to develop activities employed to enhance global business. 2.1 Industrialized Countries To achieve global status, companies in ICs usually follow the traditional process. For example a company develops step by step on their own using the high technological skills. Cost of production is controlled using energy saving devices and minimizing labour using high tech methods. The products of ICs are of high quality and ICs gradually increased their markets abroad. Assisted by IT the demand for quality goods increased to global proportions, e.g. Toyota in Japan. Another method adopted by IC companies to achieve global status is described in the following example. 2.2 An example from Sweden Since of late in Sweden the small and medium sized companies became the largest employer (Dedkov Dimitri, 2011). These companies called Born Globals came to the forefront proving that small companies are in fact able to compete in the world market on par with big companies. These companies skipped the traditional process of achieving global status as the traditional method was slow and stepwise (Madsen and Servais, 1992). Networking is an important step to internationalize the markets. A study was carried out by Dedkov Dimitri (2011) by asking questions from six high tech Swedish Companies regarding entrepreneurship, internationalization and networking. The study revealed that (a) Born globals are small and medium sized companies founded with a global vision for their products. (b) They operated in niche markets with highly specialized products destined to international markets (c) Born globals competed on the basis of providing the customer a unique product in contrast with standardized product 2.3 Industrially Developing Countries The development process in IDCs was however long and drawn out. IDCs were at a disadvantageous position struggling with traditional technology and a labour intensive society. The modern IDCs started to skip the intermediate phases and copied the technology of the West in double quick time. IDCs wanted to gain time and save money by disregarding the intermediate phases. 3 A Case Study from Sri Lanka (an IDC) 20

17 MAS Holdings (founded by the three brothers Mahesh Ajay and Sharad) (http:// is a specialist company in fabric, sportswear, lace and apparel originally which was started by investing in a small factory in 1986 with 26 sewing machines and 60 employees. In 1992 MAS entered into a joint venture with Triumph International Germany. Starting with linea clothing in Maldives in 1996 MAS made strategic investments overseas operating in five countries. MAS established stretch line (premium supplier of Elastics which is globally recognized) with Charnwood Elastic (UK). MAS with a partnership with Noyon Dentelles of France in 2004 started the first lace manufactory facility at Noyon (Lanka). MAS started a regional base for intimate apparel accessories with joint venture with Prym Intimates, Germany and Dogi International Fabric and Test point SA in Spain. Encouraged by consumers increasing demands for ethically manufactured products, MAS adopted internationally accepted standard of employee well-being and social accountability. For purpose of improving efficiency and deliver faster turnaround time, MAS implemented the MAS Operating System (MOS), a lean manufacturing philosophy based on Toyota Production System. Anticipating a shift in the industry orientation from service to knowledge, MAS set up MAS Institute of Management Technology to function as a centre of industry knowledge and innovation in liaison with internationally reputed academics. After consolidating its position in Sri Lanka, MAS expanded to India through the development of an integrated apparel and fabric park. From an entrepreneurial venture MAS has grown to a global entity. MAS in excelling every aspect of the business has won numerous awards including 5S, all star and national productivity. Last year MAS won the coveted vendor of the year award. A demonstrated commitment towards employee well-being, health and safety and working standards has earned Willis Caroon Risk Management and the Sara Lee Corp of Millionaires Club Award and a Award for Health and Safety. MAS launched a unique Corporate Social Responsibility (CSR) initiative in 2004 titled MAS Women Go Beyond to empower employee with training and development to advance their careers while successfully balancing their personal lives. This initiative won the American Apparel and Footwear Association Award for Excellence in CSR in MAS has won international acclaim through the UN Global Compact for best practices, embedding human rights in the work place. MAS is currently ranked 14 th among Top Twenty Asian Progressives (World Business) and 4 th among Sri Lankan Most Respected Entities. MAS has been regularly featured in the international press with emphasis on its ethics and innovative people-management practices. It reflects a passionate and competitive spirit balanced by unmatched commitment towards employee well-being through all media. It is seen that a company which started a factory operating 26 sewing machines and 60 employees in 1986 developed into a globally accepted company with global business and winning several esteemed awards. The remarkable success of MAS although can be attributed to several factors of which the importance given to human worker or human factors is clearly evident. MAS management indicated its interest to practice human factor sciences in the workplaces as early as In the late 90s the author of this paper was invited to conduct a one week intensive programme in ergonomics theory and practice to participants selected from human resources and shop floor supervisory personnel from the apparel industry. From this time onwards ergonomic surveys or short training programmes were conducted by ergonomic experts from Sweden. Recently in March 2011 an intensive programme in ergonomics (theory and practice) was given to 12 participants who were black belt holders from the MOS group selected from several apparel factories belonging to the MAS Holdings in Sri Lanka. This programme was conducted by the author of this paper. The programme consisted of two theoretical modules, two applied ergonomic modules, a training in ergonomic methodology in actual workplaces and finally the participants were required to carry out individual mini ergonomic projects. Although it was a 4 day intensive programme the performance in their mini projects of the majority of participants were of high standard which were comparative to that of experts in ergonomics practice. Follow up work is 21

18 proposed and planned to be carried out in the near future. The participants were asked to answer the two following questions at the conclusion of the programme. 1. Were you exposed to a training programme in ergonomics where the theory of ergonomics was taught? Eighty percent answered in the negative. 2. Was the knowledge gained from this programme useful? One hundred percent answered YES. An in-depth search of the background of the 12 participants who were black belt holders indicated that they have already gone through intensive training programmes in the following methodology modules which were requirements to reach the black belt status. These strategies and their relevance to human factors have been described below. 3.1 Lean Manufacturing (http://en.wikipedia.org/wiki/lean manufacturing) Lean can be defined as set of strategies employed to increase efficiency and decreasing waste and using empirical methods to decide what matters. Lean emphasizes identification and steady elimination of waste. It improves quality flow and smoothness of work and reduces production time and cost. In eliminating waste using lean strategies the following methods are employed which are similar to Organization Design And Management (ODAM) methods as advocated in applied macro-ergonomics by Hendrick and Kliever, (2002). - Eliminate transport not required for production - Eliminate motion of people and equipment not required to perform the processing - Eliminate waiting for next production - Eliminate over-production or production more than the demand - Eliminate efforts to inspect and fixing defects In improving lean or organizational change the neglect of the human beings has caused implementation problems resulting in enormous wastage of money spent on improvement strategies (http://lean ). Since people are part of the system and part of the process their interactions with others and technical processes are important. As to why lean manufacturing has taken over 25 years to make a significant impact in US has been the neglect of the human being. 3.2 Kaizen: (http://en.wikipedia.org) Kai means change and Zen means good. The overall meaning of Kaizen is Improvement. Kaizen is a humanized approach to work with the aim of increasing productivity. The worker participation in applying improvements and encouraging workers to take ownership for the work are strategies used in Kaizen which reinforces the team work and motivates the worker. Since improvement ideas actually come up from the workers they are easier to implement. Kaizen adopts smaller experiments and small changes rather than large scale pre-planning and project scheduling. Lastly Kaizen generates total quality management (TQM) and frees human efforts through improving productivity. It is seen that Kaizen aims at total harmonization of work which is in effect a human factor science strategy. 3.3 Six Sigma: (http://en.wikipedia.org) Six Sigma has been inspired by six preceding decades of quality improvement methodologies such as Quality Control, TQM and Zero Defects. A special infrastructure of Champions consisting of Master Black Belts, Black Belts and Green Belts have been established to lead and implement Six Sigma approach. The goal of Six Sigma is to improve all processes to that level of quality or better. Six Sigma ideas have been combined with lean manufacturing to yield a methodology named Lean Six Sigma. 22

19 The aim of human factor sciences is to optimize work and reduce defects, cut down costs and improve quality of products. Therefore Six Sigma is in fact a good methodology to achieve the aims of human factor sciences or ergonomics S:(http://en.wikipedia.org) 5S is a popular Japanese methodology aimed to achieve the objectives in good housekeeping. 5S has been successfully introduced in factories and work places. Realizing the ease of implementing this method 5S has been applied in offices, hospitals, schools and in domestic environments. There are five primary phases of 5S, viz. Sorting, Straightening, Systematic cleaning, Standardizing and Sustaining. Some additional phases sometimes included are Safety, Security and Satisfaction. - Sorting (Seiri) is to keep only essential tools for work and to eliminate unnecessary tools, parts and instructions. - Straightening (Seitori) or safety is to label and demarcate each item and kept in a place which is easily accessible. Each tool or equipment kept close to where it will be most used. In other words straightening the flow path and simplifying the operation - Systematic cleaning (Seiso). At the end of each shift, clean and replace tools and keep them where they belong. A key point is that maintaining cleanliness should be part of the daily work - Standardizing (Sieketsu) means that the work practice should be consistent and standardized. All work stations for a particular job should be identical. To adhere to the first 3 Ss everyone should know exactly what his or her responsibilities are. - Sustaining (Shitsuka) is to maintain focus on the new way according to 4Ss and do not allow a gradual decline back to the old ways. It also allows thinking about better ways or still a new way or tool. It is seen that the 5S methodologies have a remarkable comparison to the methodologies applied in ergonomics and particularly in good housekeeping. 3.5 Quality Function Deployment (QFD)(http://en.wikipedia.org) QFD is a means for developing usable products. By employing this method the human needs are systematically matched with the product characteristics. The importance of the different product characteristics are analyzed and the most important characteristic receives the highest ranking. The purpose of the QFD analysis is to fulfill the customer needs. Therefore each product characteristic is given a target value or standard value taken from relevant standard or opinion of experts. Technical analysis is carried out by comparing the customer needs and product characteristics and overall weighting is arrived. Based on this weighting preferences in design changes can be made. In QFD analysis a matrix is used which is called the house of quality where the analysis is carried out through a number of steps as described by Bergquist and Abeysekera (1996). QFD has been used successfully by many Japanese firms most notably Toyota. Ergonomics aims at meeting the demands of a customer. A high quality product is therefore regarded as an ergonomic product. QFD method can be used for developing ergonomic or usable product. It can be compared to participatory ergonomics where the end users are involved in developing and implementing the technology (Imada and Noro, 1991). 3.6 Discussion of the Case Study The case study carried out at MAS Holdings (an apparel industry in Sri Lanka) has been aimed to illustrate the following. - The path followed by a company in an IDC to achieve the global status in business 23

20 - The possible causes of the company s successful strategy - The intensive training programme scheduled for the personnel to reach the level of black belt members. - The influence of human factor science discipline in the training schedule given to black belt members. The purpose of the detailed explanation given above on the training programmes which were followed by black belt members is to illustrate the fact that although the training undergone by the black belt members consisted of clear ergonomic methodologies the members had not been exposed to learning the science of ergonomics. This fact was revealed by the answers given by the participants at the conclusion of the ergonomic programme held recently. It is noted that there was a remarkable performance of the participants in the mini ergonomic projects carried out at the end of the ergonomic training course. It can be concluded that the participants who had already practiced ergonomic methodologies (although they were not quite aware that they were ergonomic methodologies) in their training schedule their knowledge in ergonomics became comprehensive after receiving an intensive training in theoretical ergonomics. Hence their performance in carrying out ergonomic mini projects indeed were of high standard. This case study has proved that small and medium sized companies wherever they function (in ICs as well as in IDCs) can develop their business to global status. Systematic training schedules as introduced by MAS Holdings in Sri Lanka can be a hidden strategy of success. Training in theory and practice of human factor sciences or ergonomics provided to relevant personnel are essential to achieve success by companies aspiring to achieve global business. 4 The need for Ergonomics to be a Global Science International Ergonomic Association (IEA) defines ergonomics formally as follows. Ergonomics (or human factors) is the scientific discipline concerned with understanding of the interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods of design, in order to optimize human well-being and overall system performance. The above definition clearly separates the science and principles of ergonomics and the profession that applies the theory and principles. The need for ergonomics (theory and practice) for a successful global company e.g. MAS Holdings has been adequately described in the above case study. As was mentioned in the introduction not only in production and manufacturing, even in other areas of development, viz. education, technology, economy, marketing, travel, etc., both ICs and IDCs are fast reaching global proportions. The need for ergonomic considerations in every stage in the development process in all activities has to be emphasized in order to achieve the expected results and benefits. Apart from the globalizing activity practiced by the IDCs one should not forget the leap-frogging strategy in acquiring the technology of the West which IDCs have been adopting during the past 3-4 decades. In this process of technology transfer many mistakes have occurred in overlooking ergonomic needs in the transfer process. The authors Abeysekera (1987 and 1990) and Shahnavaz (1991) have described this fact in detail in their publications on Ergonomics of Technology Transfer. These authors have adequately explained in their publications that by skipping the intermediate phases in copying the technology of the West the technology acquired by IDCS is detrimental and hazardous. 24

21 It is imperative that if global business is to be successful the acquired technology in terms of human factors should fit the users in developing societies. 5 Ergonomics of technology transfer 5.1 Ergonomic Considerations The following list very briefly describes some essential ergonomic considerations which can influence technology transfer as highlighted by the authors Abeysekera and Shanavaz in their publications. - Sizes of people: Large variations between sizes of people between ICs and IDCs (large sizes of people in ICs and small sizes in IDCs (Abeysekera, 1985). - Climate: Cold and dry climate in ICs and hot and humid climates in IDCs. The need of insulated clothing and buildings in ICs compared with the need for effective heat transfer properties in clothing and buildings in IDCs. - Physiology: Strong and muscular people in ICs compared with weak and lean people in IDCs causing significant differences in work capacities. - Manual dexterity and sharp eyesight: Nimbleness of hands and special abilities in mechanical aptitudes, e.g. Japanese has the advantage in electrical industry. They have accurate eyesight and photographic memories. - Psychology: Differences in cognitive capabilities e.g. information processing, behavior and psychomotor skills, population stereotypes are major considerations in technology transfer. - Cultural variables: How people think, feel and react. India regards a job as family responsibility, e.g. craft oriented technology. Absence of dignity of labour in IDCs. Jobs requiring personal protective devices are usually considered as jobs of unskilled labour. Blue collar and shop floor workers are paid low wages in IDCs. - Management and Organizational variables: In IDCs hierarchical decisions are taken at the top. The knowledge acquired by the job is not considered or recognized. In IDCs people work in a group which is called collectivism whereas in ICs people do one off jobs which is called individualism. - Other variables: From other variables the following are significant. There are large differences in the languages spoken in different countries which are important in respect of operating instructions that accompany goods and services. The level of education and skill vary widely between ICs and IDCs. The infrastructure viz. transport, markets, energy supplies, highways and their maintenance have also wide variations. Lastly the variations in the standard of living e.g. food, housing, transport, etc., can have an impact in the acquired technology. The above variables can give rise to undesirable effects in acquiring the technology as follows - The neglect of cultural, institutional, sociological and anthropological differences can cause incompatibility in using and dealing with foreign goods. These incompatibilities can be a primary cause of human error (Norman, 1980). 25

22 - High proportion of accident rate and occupational illnesses and low machine utilization result in low productivity (Krishna, 1980) - Massive unemployment, alienation and de-skilling of workers (Schumacher 1975). The impacts that could affect from the above variables could be summarized as follows: o Transferring a technology that is un-adapted to the national population can be called an Imperfect Transfer. o If the climatic variations are overlooked such a transfer is Inadequate. o Shortcomings in the total technological system e.g. absence of maintenance, such a transfer is Incomplete. There are also hidden factors unknown to the transferor of technology which can have a significant effect on the transferred goods and services such as: Low incomes in IDC: Wide gaps in income, high expenditure for social events such as weddings, funerals, etc. Travelling and transport: Bad roads, traffic jams, poor maintenance of roads and vehicles. Energy Supplies: Power cuts, sudden breakdowns in transformers and power stations. Education : Low IQ levels, shortage of schools and universities, curricular deficiencies. Environment: Hot and humid environment, pollution. Religious, Social and Cultural factors: 40 day fast by Muslims, children living with parents even after the age of 18 years, caste system, terrorism, unemployment and overpopulation. Management, Organizational and Administration aspects: Bribery and corruption, political influences, lethargic workers aspiring for maximum pay for minimum work absence of the dignity of labour, low job satisfaction and lack of motivation. There are special abilities and talents among people in IDCs. For example, repair and replace defective machinery, forecasting the weather, etc. People in IDCs have the ability for self development through the experience provided in their own countries. 5.2 Summary on Technology Transfer In operating global business successfully the technology transferred to IDCs (where ¾ of the world s population live) should satisfy the human factor needs as described above. It is shown that imperfect, inadequate and incomplete technology result in undesirable effects. Partly knowing the problem and making makeshift modification could create additional problems. Westerners should not measure civilization in IDCs in the same way as in the West. They should fully understand the variability in IDCs when designing and consigning goods to the 3 rd world. Inappropriate technology is not only socially destructive but also expensive economically in terms of human suffering, low productivity and material losses. The need for collaboration and communication between transferor and acquirer are emphasized. 6 IDCs and Ergonomics as a global science In early 1990s countries in the world were classified according to the levels of the technology used, e.g. ICs have advanced and developed technology whereas IDCs have developing and less developed technology (Shahnavaz, 1991). 2/3 of the world s population live in the 3 rd world (or less 26

23 developed countries) where poverty and inequality were present. During the past 20 years the speed of development of technology has been so rapid that today the countries can be classified only as advanced and less advanced. Ergonomics was a science predominantly practiced in the Western world after it was identified as a profession in 1940s. After 50 years still ergonomics is in its infancy in IDCs. They thought that ergonomics is associated with extra costs that there are more urgent matters to attend. After the rapid development process in technology experienced and achieved, IDCs will lag behind if they don t keep pace with ICs in human factor science applications. The success story of ergonomics applications in a global company operated in Sri Lanka (an IDC) has been already discussed in a case study in this paper. 6.1 The current situation in IDCs and the need for ergonomics The state of the art in IDCs and as to why ergonomics needed to be practiced in IDCs is listed as follows: - Manual labour is still a major activity - High sicknesses and accident rates - Production losses and low product quality - Great urge to acquire Western Technology - No formal ergonomic education available in Universities and for the industry - Large scale mismatches between humans and the work environment and tools - The present technology is maladjusted and old - Solutions adopted in ICs are not applicable in IDCs - The operators are not trained or familiar with occupational health and safety preventive measures - IDCs have no resources considering the enormity of the problems Therefore to realize ergonomics as a global science it is of paramount importance that IDCs must be educated and trained to apply ergonomics. Small group training based on local needs and on site and action oriented training are recommended. Workshops for factory managers and HR personnel to develop safety consciousness and training in ILO ergonomic checkpoints are also recommended. IDCs must develop their own solutions based on own standards developed through research. Solutions to problems must be cost effective. IDCs need assistance from World Ergonomic Communities on information, up to date knowhow and research cooperation in ergonomics. Lastly since human factors or ergonomics is a new discipline in IDCs, training and education in ergonomics must be introduced in the university curricula. Ergonomics deals with people and their living and working conditions which differ around the globe. To make ergonomics universal, theoretical and practical knowledge is needed and specially ergonomics of IDCs. To globalize demands social, cultural and prevailing conditions of the human at work system have to be considered in different parts of the world. Shanavaz (1996) in his Ergonomics Society lecture concludes that global ergonomics means One World concept not First World nor the Third World and to make this One World a better world with Ergonomics. 6.2 Comprehensive ergonomics as a global science Bernhard Wilpert (1994) in his presentation at IEA 1994 emphasized the fact that when 27

24 considering world ergonomics it should be directed to more comprehensive ergonomics. What is understood by comprehensive ergonomics are the changes needed to solve the new challenges that characterize work today. The global companies and migration of workers have also put forward new challenges in implementing ergonomics. The following major changes as envisaged by Bernhard (1994) in his paper are very topical and worth considering and applicable even today. - The work force has shifted from production to the service sector. - The female labour participation has increased which imposes new strategies of human resource management - In ICs with high levels of formal education demands creation of workplaces needing high levels of knowledge and intellectual competences - The average time spent of a worker in a person s lifetime has been drastically reduced during the past 50 years. - Although large number of workers is employed in small and medium sized organizations, persons employed in large complex and high hazard organizations still increase steadily. - There is a switch from physical work demands to mental information handling. The traditional units of time and space in work are breaking down. - There is frightening growth of long term unemployment. - In internationalizing markets the need to combine global thinking and local acting - The overall increase of life expectancy heralds the notion of geriatric society The above changes in the world of work are challenges that need to be tackled to make ergonomics more comprehensive. Concepts of ergonomics from traditional to present day have not so far considered the changes in the world of work. 7 Concluding remarks Globalization demands that social, cultural and the prevailing conditions of human-at-work systems are considered in different parts of the world. Ergonomics education and training today must consider new issues e.g. comprehensive ergonomics and needs in the practice of ergonomics. It is emphasized to effectively using collective resources for developing inexpensive and reliable methods for ergonomic surveys and practical means of low cost solutions for IDCs. IDC companies are rapidly infiltrating into global business and already has a major share of business. In IDCs almost ¾ of the world s population live and work. Therefore IDC ergonomics is supreme when considering Ergonomics as a World-Wide concept. 8 References Abeysekera, J.D.A Body size variability between people in developed and developing countries and its impact on the use of imported goods. International Journal of Industrial Ergonomics, 4: Abeysekera, J.D.A. and Houshang Shahnavaz, 1987., Ergonomics of Technology Transfer. International Journal of Industrial Ergonomics, 1, (1987) Amaleen Deshamanya Mahesh, years Uncovered. The MAS story. MAS Holdings, Sri Lanka 28

25 Bergquist Karin and John Abeysekera, Quality Function Deployment (QFD) A means of developing usable products. International Journal of Industrial Ergonomics 18, (1996, ) Dedkov Dimitri, 2011., Fast internationalization of Swedish micro companies (Born Globals). Masters Thesis, University of Linköping, Sweden Eason Ken, Information Technology and Organizational Change. Taylor and Francis, Hendrick Hal and Kliener B (eds) 2002, Macroergonomics: Theory, Methods and Applications, Lawrence Erlbaum Associates, ISBN Imada, A.S. and Noro, K., 1991, Participatory Ergonomics. Taylor and Francis, London Krishna, R, The Economic Development of India. Scientific American, 243(3) Norman, D.A., Errors in Human Performances, San-Diego, California. Center for Information Processing. Schumacher, E.F., Small is Beautiful. Harper and Row Publishers, New York, London Shahnavaz, H. 1991, Transfer of Technology to IDCs and Human Factor Considerations. Research Paper, Luleå University, Sweden Shahnavaz, H Making Ergonomics a World-Wide Concept. The Ergonomics Society Lecture, Ergonomics, 1996, Vol.39, No.12,

26 USER EXPERIENCE AS A CHALLENGE FOR COGNITIVE PSYCHOLOGY AND ERGONOMICS José J. Cañas Department of Experimental Psychology University of Granada, Campus de Cartuja, Granada, Spain Research on human-technology interaction has been concerned with assessing the experience of interacting with technology that is already in the process of being designed. However, nowadays the challenge is to help industry in finding out what technology should be designed. In this new context, cognitive psychology and ergonomics should be able to help the innovation process from an analysis of the actions that constitute human life and the role that technology plays in them. Keywords: User experience, innovation, Cognitive Psychology, Cognitive Ergonomics 1. Introduction In the traditional usability approach research has been guided by the question: how well do the users interact with technology? So researchers have evaluated parameters such as efficiency, effectiveness and satisfaction in order to solve any problem user had during interaction. Number of errors, time to complete the task, etc., were the variables that interested researchers. This traditional view of the human-technology interaction originated from the work of cognitive psychologies in the fields of Ergonomics and Human Factors on applied contexts where people "had to use the technology". On those contexts, users were workers that had to interact with technology to perform their tasks. Thus, cognitive psychology and cognitive ergonomics were very successful applying knowledge from information processing models of human performance to predict user s efficiency, effectiveness and satisfaction. However, researchers and industry soon realized that when we move out of the work context we find many situations in which the user "may or may not want" to use technology. Thus, while users must use computers, trucks, diggers, airplanes, etc., to perform their tasks, they might or not use mobile phones to talk with friends or to play videogames. And, they might or not use a mobile phone independently of how effective, efficient and satisfactory is the interaction with it. Therefore, researchers started to think that there have to be something else to engage user in the interaction with the technology when they do not need it for performing their work tasks. For example, if we think on a hedonic artefact such as a game console we could realized that it can be perfectly designed so that the user does not make mistakes while interacting with it, but it could also happens that she/he gets bored while playing video games. For this reason, researchers changed their focus of attention towards a vision of interaction in which concepts such as emotion, motivation, hedonic experiences, etc., have to be evaluated altogether with effectiveness, efficiency and satisfaction. And this new vision was called "user experience evaluation to 30

27 mean that interaction with technology is part of the human experience when acting in life. Therefore, we could say that User experience is an extension of the traditional usability approach to Human-Technology interaction research to include the whole user psychological, sociological and cultural experience with technology. However, it is clear that researchers evaluating user experience are still working in a situation in which they know the technology that has to be evaluated. Some times they have only a conceptual description of the technology to be designed, but some other times researchers have already a prototype of the device to be evaluated. In both cases what they need to know is only how exactly this technology will fit into user actions and evaluate it from the standpoint of usability and user experience. Nowadays, we are facing a new challenge. Although research on user experience during interaction is being very productive, mostly due to the application of psychological, sociological and anthropological knowledge, researchers have realized now that it is necessary to move one step further. What industry and society is asking from cognitive psychologists and ergonomists now is help on the process of technology innovation. Now, we must start from assuming that we do not know what kind of technology people would like to have to enhance their life, and our job is to envision that technology. Of course, people will have to use the technology that we might foresee in an efficiently, effectively and satisfactory way while have a positive experience during interaction. However, what we need now is precisely to foresee what is the technology that we need to design and that we will have to be evaluated for user experience latter on. Therefore, the challenger for cognitive psychology and cognitive ergonomics is now to develop theoretical knowledge and methodologies for helping in the innovation process that precedes user experience evaluation. 2. Our approach In the research that we are conducting at the University of Granada to address the new issues that technology innovation is raising, we are analysing the foundations of our work on cognitive psychology and cognitive Ergonomics in order to indentify the right questions that must be answered. One of these questions refers to the own meaning of world experience. If interaction with technology involves the total human experience, cognitive psychologist and cognitive ergonomists should start by asking themselves what do they mean by the user experiencing the world. In our opinion, the answer to that question comes from the fact that human beings experience the world while acting in the world. There is not experience without acting. Even when a human being is dreaming, she/he is acting in the dream. Therefore, the unit of analysis for us is the human action. We consider that the interaction of humans with an artefact occurs within a "human action". This idea has been always clear to us: the unit of analysis never was the interaction with my pencil, the unit of analysis is the act of writing a letter. The pen, paper, rubber, etc., are objects designed to be used during the act of writing. 31

28 Thus, we believe that any new technology will always serve a single purpose: to help people to act in the world. Technology must help people when they find problems acting in the world. There is not innovation if there is not previously a problem that a person is facing while acting in her life. This reasoning is in line with cognitive theories of creative processes. Current theories about the creative process say that people are creative when they are facing limits (barriers) in their actions. The results from cognitive research on creativity shows that people are more creative when they face conditions that impose limitations or constraints on the outcome that is appropriate for a particular situation. What research findings suggest is that results are most creative when people has to find a useful object created in a category that has not been able to see before. This constraint leads them to eliminate the possibility of using more conventional (less creative) process as memory retrieval. In few words, what the experimental results from cognitive psychology (Finke, 1990; Ward, Smith, and Finke, 1999) are suggesting is that we can force a person to think in new and imaginative way if we prevented using her memory to give a usual explanation or utility. Therefore, we are designing a new methodology for helping in the innovation process based on the idea of imposing limits to the actions in people daily activities. 3. A case study: Continuity Our research group participates on a government-funded Project lead by Telefónica Company on technology innovation together with other Spanish universities and industries. Our role in this project is to find opportunities for designing new technologies by applying psychological knowledge and reasoning. In the context of that project, a Telefónica engineering team is developing several concepts that would lead the process of innovation. One of these concepts is continuity. Continuity exists when the activity that is being conducted using a device can continue by using another device. In HTI (Human-Technology Interaction) the concept of continuity is the opposite concept to that of plasticity. We say that there is plasticity when a single artefact modifies itself and adapts to a new activity. We would say that a device that can move from being used as a phone to be used as a text editor would have plasticity. By contrast, continuity refers to different devices that could replace each other for the user to continue with the same activity in different situations and contexts. Figure 1. An example of continuity 32

29 Figure 1 shows an example of continuity. When we are talking on the phone while walking down the street we are doing two things simultaneously: to talk on the phone and to walk. When we reached our car we stop the action of walking in order to start driving. However, we might want to "continue" the action of talking on the phone while driving. But, in many countries this action is illegal. Therefore, many cars now have installed a device that detects Bluetooth in our phone when we entered the car and the conversation is immediately transferred to the car. We stopped talking on the phone, but can continue talking trough the car (for a video demonstration of the concept of continuity, the interested reader could see In line with conceptual development, one of our tasks in the project is to develop a methodology, based on the concept of continuity, that can afford to "discover" new technologies (Marchitto and Cañas, in preparation). The methodology we are developing consists of two parts. In the first one, researchers and participants elaborate familiar scenarios of use in which actions could be interrupted by a variety of circumstances. In the second part, researchers ask participants to imagine ways of continuing the actions after those interruptions. More precisely, these two method parts are as follow: Part I: characterization In this first part of the method, researchers and participants go through the following steps: 1. Researchers elaborate scenarios. These scenario are not complete records, but brief descriptions of some activities done at home, leaving it to the participants to add information that can characterize them better. 2. Researchers read one scenario at a time to the participants. 3. Participants are asked to think about their daily lives, and the activities and sub-activities involved in that scenario. For example: in relation to the activity "watching TV", some activities could be: to do zapping, to check out the program, to buy a program / game from the pay-tv, etc. 4. Researchers define a set of "limits" or "filters" that could act as "agents of change" by preventing continuity, leading to an interruption / disruption in the flow of operations within the same activity. For example, in relation to the activity watching TV, we might define the following filters: change of people, change of platform, and change of context. One example of change of platform could be: imagine that the remote control does not work or loses power. Part II: (exploration) In this second part of the method, researchers create a table in which the columns are the sub-activities and the rows are the filters. The inner cells are let empty. Then, researchers ask participants to fill the cells by answering to the following question: "Given this activity, and this specific sub-activities (table columns), how could you solve the problem created by the specific change factor (table rows)?". Table 1 shows some examples for the activity Watching TV. 33

30 4. Summary After years of susceful applications of psychological knowledge to the evaluation of user experience during the interaction with technology, cognitive psychology and ergonomics are facing a new challenge. What industry and society is asking from us is to help in the innovation procesess to envision the new technology that people would like to have to enhance their life. In our work in the context of innovation projects, we are developing a methodology that could be used to face that challenge. The idea behind this methodology is that innovation is a creative process that occurs when there are "limits" or "barriers" to do activities of daily life. This idea comes from research on the cognitive processes that are behind the creative process and that shows that contrary to popular beliefs innovation is not facilitated by freedon of thinking, but by imposing limitations on what could be done to reach action goals. Table 1. Example of Activity-Filters table used in the continuity case study. Type of change Sub-activities identified by paarticipants zapping discuss contents mute the volume download / purchase content consult teletext listen to the radio play with a console User Favourite channels custom Camera detection system to know who is the user. Voice detection system to know who is the user Platform screen remote control All screens are connecte d to a network. Central server that controls everythin g. Even then we can see different things in each. keyboard Seat Context room alone With wife, husband With family The TV recognizes and identifies the people, and adapt content. With friends 34

31 4. References Marchitto, M., and Cañas, J.J. (in preparation). A methodology for helping in the innovation process. Finke, R.A. (1990). Creative imagery: Discoveries and innovations in visualization. Hillsdale, NJ: Erbaum. Ward, T.B., Smith, S.M. and Finke, R.A. (1999). Creative Cognition. In R.J. Sternberg. Handbook of Creativity. Cambridge: University Press. 35

32 PARTICIPATIVE DEVELOPMENT - PRODUCTION AND ERGONOMICS Mikael Forsman 1,2 1 Division of Occupational and Environmental Medicine, Karolinska Institutet, Sweden 2 Centre for Musculoskeletal Research, University of Gävle, Sweden Ergonomists have struggled for many years, with single problem s solutions, with a limited effect; interventions where several identified problems are focused, and where these concern work organization, work methods, and physical and psychosocial work conditions have a greater effect in decreasing disorders and risk factors. Reviews of ergonomic interventions have also shown that the most successful interventions are: those with high commitment of stakeholders and different solutions on different levels are found, and those where solutions are directed towards the individual worker, whom also is actively involved (Westgaard and Winkel, 1997; Silverstein and Clark, 2004). Westgaard and Winkel (2011) recently reviewed rationalization s effects on occupational musculoskeletal and mental health reported in 162 publications. The majority, 57%, of the rationalization had a dominant negative effect on health and known risk factors, 19% showed positive effects. There were however positive modifiers, and the most pronounced ones were, similarly with their previous findings (1997): worker participation, and inclusive management style (goal clarity and transparency, dialogue, concern for workers). Although, evaluations of participative ergonomics interventions have reported mixed results, it appears clear from reviews above that in either case; when the aim is to improve working conditions and worker s health, or when the aim is to rationalize the production system for other (economical) reasons, to obtain solutions that have positive effects on worker s health, workers should participate. Participative ergonomics, where a multidisciplinary group is formed and with the support of the management, identify problems; discuss, development and implement solution, is becoming more popular among practitioners, although still far more ergonomic interventions should include more worker participation. Arguments not to include the workers in interventions are that it is too time consuming and too expensive. In Sweden, workers and management collaborations have a long history. In 1979, the Swedish Employers Association developed the vision Different kinds of factories with technical solutions and work roles based on the socio-technical approach. The union published The Good Work in The organizations agreed on collaborative development as in autonomous working groups. Those ideas can be recognised today as Lean production methodology increases worldwide; firstly in assembling, now in all sectors including social service. A key point in Lean (e.g. Liker, 2004) is continuous development of the production system, in order to maximize the costumer value. Since detailed knowledge of the production process is found among the workers on the shop-floor, participation is also included. Participation in rationalization decisions should go beyond simple consultation, and workers need to have influence. At e.g. Scania, working groups now also agree on changes in the assembly standards. 36

33 So, companies seem to increase their interest in participative development, unfortunately ergonomics is not main interest; extensive work is needed to make ergonomics an undisputed point on the agenda of development. References Liker, J.K The Toyota Way 14 management principles from the world s greatest manufacturer, New York, London: Mc Graw Hill Silverstein, B., Clark, R., Interventions to reduce work-related musculoskeletal disorders. Journal of Electromyography and Kinesiology 14, Westgaard, R.H., Winkel, J Ergonomic intervention research for improved musculoskeletal health: A critical review. International Journal of Industrial Ergonomics, 20, Westgaard, R.H., Winkel, J Occupational musculoskeletal and mental health: significance of rationalization and opportunities to create sustainable production systems a systematic review. Applied Ergonomics, 42,

34 1st Parallel Sessions Monday September 19, :30 14:50 38

35 A1 - MANAGEMENT AND DEVELOPMENT FOR SUSTAINABILITY A1.1 Interview of stakeholders in product development about quality output due to product geometry and production ergonomics Ann-Christine Falck A1.2 Towards sustainable well-being in SMEs with the Ergonetti learning program Marja Randelin A1.3 Towards sustainable work: how leadership and general life satisfaction affects on employees' occupational well-being? Liisa Mäkelä A1.4 Leadership and generations' work related wellbeing Kirsi Heikkilä-Tammi 39

36 ERGONOMICS IN EARLY PRODUCT DEVELOPMENT AN INTERVIEW STUDY IN FIVE COMPANIES Falck, A-C Department of Product and Production Development, Chalmers University of Technology, SE-41296, Göteborg, Sweden. The objective was to explore how assembly ergonomics issues were regarded in early product development. Therefore, 64 stakeholders in five manufacturing companies were interviewed. Their answers show a fairly good awareness of the implications of poor assembly ergonomics but appropriate working procedures are missing. 58 respondents think that poor ergonomics can result in worse product quality. 47 state that profitability calculations are often necessary and 37 mean that ergonomics risks are taken due to missing calculation methods. Altogether, the results add further knowledge of what is required to achieve more complete and sustainable ergonomic solutions. Keywords: interview, product development, ergonomics, manufacturing. 1. Introduction To be competitive in a global perspective, Swedish manufacturer must increase their efficiency and lower their costs. Research and experience show that as much as 10-40% of a company s total turnover is cost of poor quality (Harrington, 1987; Bank, 1992; Booker et al., 2001). This means that there is a huge improvement potential through a careful analysis of the consequences of different assembly solutions and production strategies in early product development. In the car industry this potential is particularly large in the area of geometric and production ergonomic quality. Many studies have shown that there is a clear relationship between ergonomics and product quality, e.g. Axelsson, 2000; Eklund, 2001; Lin et al., 2001; Yeow and Nath Sen, 2006; Falck et al., Products that are difficult to assemble due to tricky assembly, poor fitting or bad ergonomics also influence the geometric quality that is fit, finish and function. Others have shown that there is also a relationship between ergonomic conditions and productivity (Hendrick, 1997; Stephens, 2006; Generalis and Mylonakis, 2007). Eklund (1999) and Falck (2007) found that the ergonomic impact is caused by the product at 60-70% and by the manufacturing process at 30-40%. This means that assembly ergonomic conditions are largely decided by design solutions in early development phases of new products. Nevertheless, design engineers are often not familiar with ergonomic conditions in the factories and do not take account of the relationship between ergonomics and product quality (Broberg, 1997; Skepper et al., 2000; Langaa Jensen, 2002; Sunwook et al., 2008). Therefore, further research is required in order to find out what the deficiencies are and what the needs are, which support proactive and sustainable design solutions and consider both quality and ergonomics. 40

37 2. Objectives Thus, in a first step interview of project engineers in early product development was decided. The interview answers aim at giving a deeper understanding of the needs of better ergonomic tools and decision support in the development of sustainable and more cost-efficient manufacturing solutions and assembly methods. Another purpose is to compare how different companies look upon and handle problems and questions at issue about ergonomics, quality, geometry and requirement setting. 3. Methods 3.1 Interviews Semi-structured interviews of project engineers in manufacturing engineering (ME) and in product design (PD) were conducted in their normal work site. The questionnaire consisted of 40 semi-structured questions divided into 10 main questions and 30 sub queries. These concerned assembly ergonomics and the relationship between ergonomics, product geometry, ease of assembly and product quality and included the following areas: - The meaning of assembly ergonomics, consideration of ergonomics in new product and production design; Ease of assembly and relationship to product quality. - Incentives, terms and support needed for change of poor ergonomic solutions. - Relationship between geometry, ergonomics and quality output. - Proposals for better tools and decision support in choice of assembly solutions. 3.2 Participating companies and selection of respondents Five manufacturing companies that were already engaged in a Swedish research program in called Sustainable Production Strategies were contacted for interview. Two companies are large companies in the vehicle industry. Three are small and medium sized enterprises (SME) one of which is a supplier to the vehicle industry, one produces lighting armatures and one locker modules for delivery vans. The selection of manufacturing engineers in the two large vehicle companies was made so that these represented main product areas such exterior, interior, chassis and electrical parts and components. Contact information and suggestion of names of design engineers were obtained by the ME. In the SME: s the selection of people was made by the companies according to specifications given by the interviewers. The purpose was to reach design and manufacturing engineers but it became obvious that in the SME:s the professional roles are often mixed so that one employee sometimes has several roles. Therefore, the selection of respondents naturally differ from that in the two major companies in which employees usually have more specialized work tasks and specific role responsibilities. However, to be able to investigate the different circumstances and compare answers and comments the same questionnaire was used in all five companies. 4. Results The interviews were conducted in Each interview took about one hour to accomplish. All answers were carefully written down by the interviewer. In some cases two interviewers were present. Afterwards it was checked with the respondents that all answers were properly understood. Besides, the interviews were tape recorded. In the two large (A, B) companies 34 and 16 persons were interviewed and in the three minor companies (C, D, E) altogether 14 persons. In total 64 persons participated. The average age of the respondents was 41.8 years and their average years in their present profession was 10.8 years. Ergonomics training was 41

38 asked for since ergonomics knowledge was assumed to influence many answers. 27 of the 64 respondents had such training. 4.1 Interview questions and answers Due to the extensive response materials only some of the questions and answers can be brought up here. These are: What does the concept of load ergonomics include and what associations does it give to you in your professional role? Detailed answers and many examples showed that the respondents overall had a reasonable understanding of what is included in the concept of ergonomics. Do you consider ergonomics when you design your products? 54 of 64 respondents meant that ergonomics was considered and two meant it was sometimes considered. Some of those who answered no said that ergonomics does not have a big importance. There is short-term economy. Others gave no reason (Table 1). Table 1. Do you consider ergonomics when you design your products? Company Yes or mostly No Don t know or n/a A (large) B (large) C (SME) D (SME) E (SME) Total All respondents Do you think that poor ergonomic conditions could result in quality issues of the product? The majority, 58 of 64 persons were positive: Yes, without doubt. Yes, absolutely. Yes, I am absolutely convinced. There is a straight connection. Yes, if one does not reach/manage things go wrong. If there is poor ergonomics there will be quality problems. Non ergonomic assembly is a source of variation that must be eliminated. If it is difficult the operator will find other (less good) ways, which result in variation of the outcomes (Table 2). Table 2. Do you think that poor ergonomic conditions could result in quality issues of the product? Company Yes or mostly Sometimes Sometimes No Don t know or n/a A (large) B (large) C (SME) D (SME) E (SME) Total All respondents If ergonomics has to be considered How do you make sure that ergonomic requirements are fulfilled? As can be deduced by the answers in company A risks are proactively identified and taken care of before design solutions are fixed in early new product development. Early requirement setting is applied. Concerned stakeholders and project ergonomists are involved. In company B the working procedures are mainly reactive, meaning that risks are not identified and taken care of before design solutions are fixed. Neither production representatives nor ergonomist are involved in early development phases. The design 42

39 engineers rely heavily on the manufacturing engineers for risk detection. In company C, D and E the working procedures are reactive: Production representatives are very seldom involved before physical products exist. Ergonomist is never consulted. If an ergonomics risk is costly to eliminate what is required to solve it? In Table 5. the answers of seven sub questions are displayed. Table 5. When there is an ergonomics risk that costs money to solve what is required to solve it? Questions If an ergonomics risk is costly to eliminate - 1. is it sufficient with explicit requirements from manufacturing engineering/factory for acceptance of a product change? 2. would it be enough to refer to legal demands according to the work environment act? 3. if the ergonomics risk is also a quality risk - would this be a sufficient reason for a product change? 4. does there always have to be a profitability calculation included beside a risk assessment? Yes or mostly Sometimes No Don t know or n/a do you make profitability calculations? does it occur that risks are consciously taken in lack of profitability calculations? 7. are there (company) policy/guidelines with respect to requirement deviation? n.a All answers Do you know that poor assembly ergonomic conditions result in quality losses and high corrective action costs both in assembly and for products ready for delivery to the final customer? 50 respondents said that they thought/knew or meant that is reasonable that poor assembly ergonomics result in deteriorated quality while 14 said they did not know. What do you think about it? Company A: The general opinion is that something has gone wrong during product development when quality errors occur in production. In company B the general opinion among design engineers is that often the operators are to blame for quality errors. ME on the contrary, state that manufacturing conditions are the main reason for things that go wrong. Company C, D and E state various reasons for why poor assembly ergonomic conditions could result in quality losses and measure costs. What do you do /could you do to prevent this? A large number of improvement proposals were submitted of how to improve ease of assembly on product level and of ergonomic conditions for reduction of quality errors. The emphasis of the proposals in all five companies was on proactive design measures and actions, e.g.: Early verification of assembly solutions. Involve ergonomics specialist from the start. Identification of potential problems in early development phases. Improve ergonomics knowledge among design engineers and economists. Are geometric and ergonomic requirements often in conflict? 26 respondents meant that geometric and ergonomic requirements often are in conflict whereas 24 respondents answered seldom. 10 said they sometimes are and four did not know. What support is needed for better decisions in the choice of assembly concepts that concerns ergonomics? Many improvement suggestions were given. In short these implied: Explicit ergonomic requirement setting that should be distinct, objective and able to verify in early project phases. Feed back of earlier experience. Removal of the human factor through assembly friendly design. Show cost 43

40 consequences of improper ergonomics and assembly solutions. Ergonomic profitability calculations in early project phases. Virtual simulation tools for assessments of ergonomics and geometry before products exist in real. Better training in ergonomics and of design engineers in particular. A long-term approach and thorough cross-functional concept work was emphasized. In company A it was stated that communication is often the major problem and not the technology. 5. Discussion Although the conditions varied between the participating companies, the majority of the answers showed a fairly good awareness of the consequences of poor ergonomics. Most respondents thought that there was a strong relationship between assembly ergonomics and quality output and that difficult ergonomic conditions result in increased risks of assembly-related errors. Yet, the working procedures and assessment tools do not reflect these insights in four of the five companies - why? Still, the most probable reason is lack of training and ergonomics knowledge among designers, decision makers and management in those companies who do not understand the full benefits of good ergonomics and assembly ability. Another reason may be that legal demands and ergonomic standards are usually generally written, which means that they are not adapted for proactive risk assessment by project engineers in early product design. Thus, a combination of a lack of ergonomics knowledge among engineers, managers and decision makers beside a lack of suitable assessment tools might explain the poor status of ergonomics. In Sweden, companies usually have cooperation with Health & Safety companies, which often have employed ergonomists. However, these usually work at factory level and are rarely involved in early project contexts. Furthermore, in many cases design departments are often located geographically far from the production units, which complicate communication between stakeholders. A good example showing the usefulness of adapted ergonomics training and suitable working procedures is demonstrated by company A. There the number of trained employees was much higher than in the other four companies. All manufacturing engineers had to undergo four days of training, which was lead by the ergonomic specialists who also worked in new product development projects. In this study 13 of 16 engineers had such training. In PD only four of 18 engineers were trained. Nevertheless, it was obvious that the cross-functional cooperation between ME and PD had lead to a high awareness also among design engineers. In company B three of six manufacturing engineers and in PD one of nine engineers was trained. ME believed that ergonomics training should improve the understanding of assembly conditions and facilitate cooperation between design and manufacturing. In the SME:s one mainly tried to solve problems when they occurred in running production and in late project phases. Three of 14 respondents had ergonomics training but in general this was unusual. 6. Conclusions There are European standards and extensive Swedish work environment legislation but this fact does not sufficiently help solve the basic problem of poor ergonomics and often results in reactive measures regarded as costs and not investments that pay off. Proactive ergonomic measures are very difficult to obtain if there is a shortage of knowledge and crossfunctional cooperation in early decision phases. This requires adapted ergonomics knowledge, suitable requirements touchdown and suitable work procedures to achieve sustainable assembly solutions and long-term profitability. 44

41 In order to demonstrate the benefits of good ergonomics profitability calculations, hard facts and figures and quality impacts are often required in comparison and final choice of assembly solutions. 7. References Axelsson, J. (2000). Quality and Ergonomics. Diss., Department of Mechanical Engineering, University of Linköping, Sweden. Bank, J. (1992). The essence of total quality management. Prentice Hall, New York, ISBN: x. Booker et al (2001). Designing Capable and Reliable Products. Butterworth-Heinemann, Oxford, ISBN Broberg, O. (1997). Integrating ergonomics into the product development process. International Journal of Industrial Ergonomics 19: Eklund, J.(1999). Ergonomics and quality management humans in interaction with technology, Work Environment and Organization. International Journal of Occupational Safety and Ergonomics, 1999, Vol. 5, No 2, Eklund, J. (2001). A developmental quality approach for ergonomics. In Proceedings of the SELF-ACE 2001 Conference Ergonomics for changing work. Falck (2007). Virtual and Physical Methods for Efficient Ergonomics Risk Assessments A Development Process for Application in Car Manufacturing. Thesis for the licentiate of philosophy. Chalmers University of Technology, Göteborg, Sweden. Report no. 21 ISSN Pp Falck, A. Örtengren, R., Högberg, D. (2010).The Impact of Poor Assembly Ergonomics on Product Quality: A Cost Benefit Analysis in Car Manufacturing. Human Factors and Ergonomics in Manufacturing & Service Industries 20 (1) (2010). Generals, G., Mylonakis, J. (2007). Productivity and Ergonomics: A Strong Relationship Leading to Best Working Results. European Journal of Social Sciences Volume 5, Number 1 (2007). Pp Harrington, H.J. (1987). Poor Quality Cost. New York: Dekker, ISBN html. innehållsansvarig: Jan T. Persson. (senaste uppdatering: ). Hendrick, H.W. (1997). The cost benefits of ergonomics in product design: some empirical results. Proceedings of the 13th Triennial Congress of the International Egonomic Association. June 29 July 4, 1997, Tampere, Finland. Langaa Jensen, P. (2002). Human factors and ergonomics in the planning of production. Int. J. of Ind. Ergonomics 29 (2002) Lin, L., Drury, C.G., Kim, S.-W., (2001).Ergonomics and quality in paced assembly lines. Human Factors and Ergonomics in Manufacturing, Vol. 11 (4) , Skepper, N., Straker, L., Pollock, C. (2000). A case study of the use of ergonomics information in a heavy engineering design process. International Journal of Industrial Ergonomics 26 (2000) Stephens, A. (2006). The truck that Jack built. Virtual environments and human modeling in the design of work cells and product design, Ford Motor Company, Dearborn, Michigan, USA, Sunwook et al.(2008). Knowledge and opinions of designers of industrialized wall panels regarding incorporating ergonomics in design. Int. J. of Ind. Ergonomics38 (2008) Yeow, P., Nath Sen, R. (2006). Productivity and quality improvements, revenue increment, and rejection cost reduction in the manual component insertion lines through the application of ergonomics. International Journal of Industrial Ergonomics, 36 (2006)

42 TOWARDS SUSTAINABLE WELL-BEING IN SMEs WITH THE ERGONETTI LEARNING PROGRAM Randelin (Pitkänen) M. 1,2, Saaranen T. 3, Naumanen P. 4, Louhevaara V. 1 1 University of Eastern Finland, Department of Biomedicine, P.O. Box 1627, FI Kuopio, Finland 2 University of Eastern Finland, Aducate, Open University, P.O. Box 1627, FI Kuopio, Finland 3 University of Eastern Finland, Department of Nursing Sciences, P.O. Box 1627, FI Kuopio, Finland 4 Finnish Institute of Occupational Health, P.O. Box 310, FI Kuopio, Finland The purpose of this study was to identify and describe the characteristics of the Ergonetti learning program that promote sustainable well-being at work implemented in the SMEs. The data was gathered through interviews of 14 Ergonetti students who participated in the study. The data was analyzed using content analysis in the frame of sustainable well-being at work and organizational learning. In the light of promoting sustainable well-being at work the Ergonetti may be considered an efficient and straightforward distance learning program accessible via the Internet. Key words: Well-being at work, Sustainable development, Web-based learning, Organizational learning, SMEs 1 Introduction The promotion of well-being at work in the framework of sustainable development can be seen as a challenge and opportunity for organizations to achieve goals such as a healthy working place without depleting natural resources and the ability of future generations to meet their needs (UN 1992; WHO 1994). The promotion of well-being at work is multidimensional and requires both strengthening of a worker s individual resources, including professional competence, and the developing of the content of work as well as the working environment which includes physical and psycho-social aspects (Ilmarinen 2006). Promoting well-being at work in the context of sustainable development is a complex and dynamic issue (Hasle and Jensen 2006). To enhance sustainable well-being at work, new and innovative thinking, adopted through organizational learning (OL), is a requirement (Siebenhüner and Arnold 2007). Scott (2008) also suggests that the key activities which promote sustainable development at work are associated with the learning of ergonomics. Potential solutions or options to promote well-being at work may rise from the learning of ergonomics (Pitkänen et al. 2008). Small- and medium-sized enterprises (SMEs) are a heterogeneous group of companies (Saru 2007) that have less resources, time, money, skills, and knowledge to promote sustainable development and sustainable well-being at work than large companies. However, the new economic and ecologic thinking demands SMEs to invest time and resources for the promotion of their work and business towards sustainable development (Crals and Vereeck 2005). Promoting sustainable well-being at work through OL has scarcely been the focus of empirical research. 1.2 Sustainable well-being at work in the context of organizational learning Organizational learning OL can be seen as a primary tool used by organizations or the working life in general for develop work since it has been argued that knowledge is to become the most important asset of human capital. Today, competent workers are indispensable and a valuable resource for organizations (Saru 2007). 46

43 OL can be realized on an individual, team, and organizational level (Bucic et al. 2010). OL should be seen as a process where the knowledge of each individual increases and can be hence implemented to the knowledge base of the organization. Sharing of knowledge is essential in OL. It also enhances the creativity of organizations through the collaboration of individuals and their capacity to innovate (Nonaka and Takeuchi 1995). According to Molnar and Mulvihill (2003), OL that focuses on sustainability is also a team learning process where organizations engage in sustainable development. Organizational knowledge can be explicit and tacit. The content of explicit knowledge consists of formal rules, tools, and processes which make it easier to transfer and share. Tacit knowledge is intuitive and unarticulated. It is something what we know, also described as knowhow, but cannot explain. Therefore, tacit knowledge is difficult to transfer and share. However, shared tacit knowledge would be vital to ongoing development of organization (Becerra et al. 2008) Promotion of sustainable well-being at work by learning Based on the analyzed literature which are presented in following three chapters promotion of sustainable well-being at work by learning has been identified characteristics related: (1) to the promotion of a worker s capabilities and competence, (2) to the promotion of work organization and environment, and (3) to the promotion of leadership. The promotion of a worker s capabilities and competence by learning in the context of sustainable development demands an active collaboration between work colleagues (Sammalisto and Brorson 2008), an active reflection on new information together with other workers (Hasle and Jensen 2006), and a voluntary participation to the training program as it guides the learning process better than if the participation was to be compulsory (Helmfrid et al. 2008). The promotion of work organization and environment by learning in the context of sustainable development requires active and conscious changes in the goals and values of the organizations (Hasle and Jensen 2006). The implementation of these changes were slow with using small steps and enhancing common understanding between all working partners was more efficient than trying to solve problems immediately (Fresner and Engelhardt 2004). The promotion of leadership skills by learning in the context of sustainable development requires a commitment from the managers and true leadership skills. After the learning process, the implementation of sustainable development requires changes in the values of organization and its working culture. The entire personnel must accept these changes and commit to them and the leading manager should be involved in the process as his or hers support is important (Perron et al. 2006) The Ergonetti Current information and communication technology allows organizations to achieve, process, store, and exchange information, for instance, on the Internet (Cegarra-Navarro et al. 2007). The Internet also works as an effective tool or system that enables distance teaching and learning, and as a means to share acquired knowledge and experience on workplaces (Pitkänen et al. 2008). Distance teaching and learning is also economic and energy efficient which are two important elements of sustainable development (Barratt 2006). The Ergonetti is a web-based and basic level ergonomics program and that consist of 25 study credit points at the University of Eastern Finland. The program is offered in Finnish language but the web- 47

44 based learning environment is available all over the world through the Internet (Ergonetti 2011). The theoretical framework behind the program is based on the Finnish concept of workplace health promotion (e.g., Ilmarinen 2006), the theory of on-the-job learning (e.g., Pohjonen 2002), and Kolb s developmental cycle (Kolb 1984). The learning program supports and aims to increases activities that promote well-being at work within four dimensions: (1) Worker capabilities, (2) Professional competence, (3) Work and work environment, and (4) Organization and leadership. The learning tasks of the program consist of various developmental activities which are carried out at actual workplaces where the personnel's different views and experiences are discussed, and improvements are based on consensus. Learning is cyclic having phases to measure, analyze, understand, and solve problems within close collaboration between workers and managers who also learn alongside with the student. Previously, the learning program has shown to be an efficient learning tool that provides a way to identify, understand, and solve problems in terms of economy, advantage in costs, production, and quality (Pitkänen et al. 2008). 2 Objectives The object of this study was to identify and describe characteristics of the Ergonetti learning program that promote sustainable well-being at work implemented in the small- and medium-sized enterprises (SMEs). In this study, the Ergonetti learning program being accessible through the Internet is considered a catalyst at workplace to enhance OL at the individual, team, and organizational level in the context of sustainable well-being at work. The participants comprised of 10 women and 4 men who participated in the study and carried out the Ergonetti learning tasks in 10 different SMEs representing furniture, clothing, forest, engineering industries, service homes and corner shop. 3 Methods The data was gathered through individual thematic interviews and analyzed using the inductive content analysis (Huberman and Miles 1994) in the framework of sustainable well-being at work and OL. The data was summarized into a document of 151 pages. The characteristics of the learning program which promote sustainable well-being at work were identified from the data. The authentic expressions were simplified, after that the sub- and main categories describing sustainable well-being at work were formed from the simplified expressions. Each main and subcategory were named and grouped according to its content. The atlas.ti 5.2 program was utilized in the analysis. 4 Results The action characteristics of the learning program of ergonomics that promoted sustainable wellbeing at work in relation to a worker s individual capabilities and competence were: actions to support worker s physical capacity increased by the workplace s own actions, or through the collaboration with the occupational health services, and actions to support workers competence increased at the workplace. Various successful campaigns were arranged and permanent actions were developed to improve physical fitness of the workers through their own activity at the workplace or in the collaboration with the occupational health services. Training and education were arranged according to the workers needs. The outcome characteristics of the Ergonetti that promoted sustainable well-being at work in relation to a worker s individual capabilities and competence were: workers health and well-being increased, workers attitudes became more positive and their competence for developing work increased, so the quality of work outcomes was better, the participants competence in ergonomics 48

45 increased. By investing time and resources to maintain mental and physical well-being, it was possible to increase the health and well-being of the workers. Both the participants as well as the workers learned to develop work with positive attitudes. The outcome characteristics of the learning program of ergonomics that promoted sustainable wellbeing at work in relation to work organization and environment were: development of working methods increased at workplaces, development of working tools increased at workplaces, and development of working conditions and work community. Within the work community, the learning program provided a better collaboration and interaction among the workers. Work principals and prerequisites were also clarified and developed together at the workplaces. The outcome characteristics of the learning program of ergonomics that promoted sustainable wellbeing at work in relation to leadership were: manager s competence in managerial tasks and wellbeing increased, management support for developing the work and workers increased, and communication in the work community was developed with the support of management. Managers received valuable knowledge on various actions of development, and they realized that by working together successful developmental processes were achieved better than by working alone. 5 Discussion and conclusions The use of the content analysis enabled better understanding of contextual characteristics of the Ergonetti promoting sustainable well-being at work than using quantitative methods. The generalization of the present results may be difficult and should be done carefully due to the small number of participants and different enterprises. All levels of the OL actualized well in the learning program. The team and organizational levels of OL begun in mutual discussions and increased as the developmental work was being executed. The students, who participated in the study, learned at the individual level of the OL, and the learning was mainly explicit (e.g., Bucic et al. 2010; Nonaka and Takeuchi 1995). However, the awareness of tacit knowledge was increased amongst the workplaces when the developmental principals for developing the work environment and work community were clarified during discussions (e.g., Becerra et al. 2008). The prerequisites for the actualization of the developmental work were the positive attitudes among the workers and an open atmosphere at the workplace. Open atmosphere encouraged the workers and opened possibility to participate in genuine cooperation, reflection, and discussion. These improved the quality of the results obtained from the developmental work as well as the sustainable well-being at work of the workers. Similar results have also been reported by Sammalisto and Bronson (2008). On the other hand, the cyclic model of the learning program as a means to support developmental work demands close cooperation at the workplace (e.g., Pitkänen et al. 2008). The managers were actively involved in the discussions of developmental procedures and agreed on the methods that were to be used. They committed and encouraged and gave the workers more possibilities to participate in the developmental work. These results are similar to those obtained from previous studies that explored sustainable well-being at work focusing on leadership (Perron et al. 2006). All the students involved were active and the enterprises had a positive outlook in the developmental tasks of ergonomics. All enterprises, regardless of their size, achieved significant outcomes in the developmental tasks. Half of the students were either owners of their own enterprises or in the management position and this might have had an effect on the quick progress in 49

46 the developmental work. On the other hand, some of the students held a lower level position and also they inspired other workers and management to get involved in the developmental work as they themselves gained more competent. 6 References Barratt, R.S Meeting Lifelong Learning Needs by Distance Teaching - Clean Technology. Journal of Cleaner Production, 14(9-11), Becerra, M., Lunnan, R. & Huemer, L Trustworthiness, Risk, and the Transfer of Tacit and Explicit Knowledge between Alliance Partners. Journal of Management Studies, 45(4), Bucic, T.L., Robinson, L. & Ramburuth, P Effects of Leadership Style on Team Learning. Journal of Workplace Learning, 22(4), Cegarra-Navarro, J.G., Jiménez, D.J. & Martínez-Conesa, E.Á Implementing E-business through Organizational Learning: An Empirical Investigation in SMEs. International Journal of Information Management, 27(3), Crals, E. & Vereeck, L The Affordability of Sustainable Entrepreneurship Certification for SMEs. International Journal of Sustainable Development & World Ecology, 12(2), Ergonetti Ergonomian ja työhyvinvoinnin opintokokonaisuus verkossa. Retrieved from (15 August, 2011) Fresner, J. & Engelhardt, G Experiences with Integrated Management Systems for Two Small Companies in Austria. Journal of Cleaner Production, 12(6), Hasle, P. & Jensen, P.L Changing the Internal Health and Safety Organization through Organizational Learning and Change Management. Human Factors and Ergonomics in Manufacturing, 16(3), Helmfrid, H., Haden, A. & Ljung, M The Role of Action Research (AR) in Environmental Research: Learning from a Local Organic Food and Farming Research Project. Systemic Practice and Action Research, 21(2), Huberman, A.M. & Miles, M.B Data Management and Analysis Methods. In Denzin, N.K. & Lincoln, Y.S. (Eds), Handbook of Qualitative Research, (pp ). Thousand Oaks, CA, US: Sage Publication Inc. Ilmarinen, J Towards a LONGER WORKLIFE! Ageing and the Quality of Worklife in the European Union. Jyväskylä: Finnish Institute of Occupational Health and Ministry of Social Affairs and Health. Kolb, D.A Experiential Learning: Experience as the Source of Learning and Development. Prentice-Hall: Englewood Cliffs (NJ). Molnar, E. & Mulvihill, P.R Sustainable-Focused Organizational Learning: Recent Experiences and New Challenges. Journal of Environmental Planning and Management, 46(2), pp Nonaka, I. & Takeuchi, J The Knowledge-Creating Company. How Japanese Companies Create the Dynamics Innovation. New York: Oxford University Press, Inc. Perron, G.M., Côté, R.P. & Duffy, J.F Improving Environmental Awareness Training in Business. Journal of Cleaner Production, 14(6-7), Pitkänen, M., Naumanen, P., Ojanen K. & Louhevaara, V The Ergonetti - Web-based Ergonomics Studies: A Qualitative Case Study. The Open Education Journal, 1, Pohjonen, E On-the-job Learning in Finland. The Education System under the National Board of Education. National Board of Education eds. Helsinki, Finland: Printing Hakapaino Oy. Sammalisto, K. & Bronson, T Training and Communication in the Implementation of Environmental Management Systems (ISO 14001): A Case Study at the University of Gävle, Sweden. Journal of Cleaner Production, 6(3) Saru, E Organisational Learning and HRD: How Appropriate Are They for Small Firms? Journal of European Industrial, 31(1),

47 Scott, P Global Inequality and the Challenge for Ergonomics to Take a More Dynamic Role to Redress the Situation. Applied Ergonomics, 39(4), Siebenhüner, B. & Arnold, M Organizational Learning to Manage Sustainable Development. Business Strategy and the Environment, 16(5), UN Conference on Environment and Development. Rio de Janeiro, Brazil, Agenda 21Programme of Action for Sustainable Development. WHO Global Strategy on Occupational Health for All: The Way to Health at Work. Recommendation of the Second Meeting of the WHO Collaborating Centres in Occupational Health, October 1994, Beijing, China. 51

48 TOWARDS SUISTAINABLE WORK: HOW LEADERSHIP AND GENERAL LIFE SATISFACTION AFFECTS ON EMPLOYEES OCCUPATIONAL WELL-BEING? Liisa Mäkelä, Riitta Viitala and Sari Hölsö University of Vaasa, Department of Management, P.O.Box 700, VAASA, Finland. The purpose of this paper is to study how coaching leadership, leader-member exchange relationships, life satisfaction and occupational well-being are related to each other. The quantitative data (N 114) was collected by questionnaires from employees of four business units in a logistics company. Using regression analysis, our results show that coaching leadership and LMX relationships are statistically significantly related to job satisfaction and job strain. Moreover, general life satisfaction explains statistically significantly job satisfaction. Using cluster analysis we identified four groups representing different kind of working life experiences. The groups were named: we can do this, slaving away, nine to fivers and the happy-go-luckies. The sub-unit and the length of the LMX relationship were related to the composition of the group. Keywords: Job Well-Being, Coaching leadership, Leader-Member Exchange relationship, General Life Satisfaction 1. Introduction Occupational well-being refers to an employee s ability to manage his / her daily workload. Factors like the physical, mental and social condition of the employee, as well as the working environment and work community all relate to this ability (The Ministry of Social Affairs and Health in Finland, 2005:17). Job wellbeing is regularly studied through concepts such as commitment, job satisfaction and work-life balance (Baptiste, 2008). Job satisfaction, a very important element of job well-being, can be defined as a person s satisfaction or dissatisfaction with their job and with other factors related to the job (e.g. wages, colleagues) (Danna and Griffin, 1999; Ghazzawi, 2008). The negative side of job well-being can be studied through considering workload or job strain, focusing on the extent to which individuals perceive their workloads as onerous. In this study, job well-being is studied through job satisfaction and job strain. One of the most important antecedents related to job well-being is the way in which people in organizations are managed (e.g. Moyle, 1998; Gardner and O Driscoll, 2007). The key person in the leadership process is the employee s immediate supervisor, as they have the ability to, for instance, increase job satisfaction through supervisory support and also to create stress by unfavourable leadership behaviour (Kuoppala et.al, 2008). Leadership can be seen as a process occurring between supervisor and the subordinates. Leader-Member Exchange theory (LMX) (see Graen and Uhl-Bien, 1995) focuses on leadership from this perspective. Each supervisor-subordinate dyad is unique and the quality of the dyad varies from low to high. Earlier studies have shown that the quality of LMX relationship is related to job satisfaction; higher LMX quality relates to higher job satisfaction (Erdogan and Enders, 2007). A leadership style which empowers employees to exceed prior levels of performance has recently often defined as coaching (Evered and Selman, 1989). The idea of coaching is to ensure employee s job satisfaction, learning and good performance simultaneously. Therefore, both of these perspectives on leadership; coaching leadership and LMX relationships are taken into account in this paper. 52

49 Occupational well-being is not only the consequence of organizational aspects. Also non-work elements, e.g. work-family conflicts, are found to be important (refs). However, there is a dearth of empirical studies taking account both leadership and general life satisfaction perspectives and therefore general life satisfaction is studied in this paper together with coaching leadership and LMX relationships. The aim of this paper is to study empirically how coaching leadership, leader-member exchange relationships, general life satisfaction and job well-being relate to each other. Next, the theoretical basis of this study is presented, followed by the description of the study methodology and the results of the study. At last we present some conclusions. 2. Occupational well-being, general life satisfaction and leadership Recent decades have seen the general discussion of well-being in general, and at workplaces in particular, increase dramatically. In daily speech well-being is usually meant to be a comprehensive sense of a good feeling about life as a whole or good physical health. Researchers have previously been interested in elements of well-being and how it is experienced and the antecedents and consequences of well-being (Danna and Griffin, 1999). One of the most researched themes in organizations is job satisfaction (Ghazzawi, 2008). Although many researchers have used job satisfaction as a measure of affective well-being and especially in measuring happiness, some of their colleagues have criticized the approach for ignoring the employee s life outside work (Schultz, 2008; Wright and Cropanzano, 2000). Judge and Locke (1993) consider that the relationship between well-being and job satisfaction is related to how important work is in the employee s life as a whole. Workload, or strain, can be physical or mental. The mental workload can be experienced when an employee feels that the demands of work are relatively higher than the employee s locus of control (i.e. the degree to which the employee has the required skills and knowledge to manage their work and the opportunity to control their work) (Karasek, 1979). Number of studies have found out, that the three most common factors involved in job dissatisfaction are work demands, lack of support and lack of opportunity to control the work (Way and MacNeil, 2006). When work is mentally demanding over an extended period and the demands are strong enough, the employee is likely to experience stress which may bring broader problems like burnout (Maslach and Jackson, 1981). The way that employees are managed is related to job well-being (e.g. Baptiste, 2008). Nevertheless, prior research about the relationship between leadership and job well-being has viewed this dimension quite superficially and therefore we shortly discuss on coaching leadership and LMX-research more thoroughly. 3. Coaching leadership and LMX relationships Coaching leadership style has been said to be effective in rapidly changing work environments. Among others, better motivation, lower staff absence and improved employee retention have been claimed to be the benefits of developing coaching leadership in a company (Pollit 2009). Essential features in relationship between a coaching leader and a follower are open communication (Ellinger et.al. 1999), constructive feedback, which generates a feeling that people are respected and valued, and mutual trust. Important characteristics connected to coaching leaders are empathy, honesty and neutrality, motivation to act with coaching methods, the belief that each employee has the potential to learn and develop (Whitmore, 2007:16), and the ability to recognize the needs of employees and adopt a proper coach role whenever it is 53

50 needed (Viitala, 2007). In general, literature on coaching leadership focuses on a leader and it is generally assumed that coaching leadership is a single entity that can be experienced collectively in the same way. However, it has been discovered, that employees assessments of coaching diverge even when they assess the same leader (Viitala, 2004) LMX is based on the argument that leaders and their followers create dyadic working relationships which differ from each other in quality. Leader-follower relationships are mutually constituted and co-produced (Collinson, 2005; Mäkelä, 2009) and fundamentally reciprocal. The status of these relationships is seen as a continuum with high quality relationships at one end and low quality leader-follower dyads at the other (Liden and Maslyn, 1998). Relationships between leaders and their followers are supposed to develop rather quickly and then remain stable. 4. Method The original sample (N 114) included employees from four business units of one large organization in the logistics-sector. The subunits structure and situational factors differed from each other. There were three relevant differences between the units: 1) in one of them the supervisor was new and had worked with the subordinates for only two weeks at the time this data collected, 2) one of these subunits is located in four separate locations and the supervisor visited each place at least once a week, and 3) one unit is considerable bigger than others, even though the number of respondents was about the same than from other units. The data collection was performed in autumn 2009, using a questionnaire distributed and collected by a researcher to each employee at a workplace meeting. The questionnaire included scales for measuring Leader-Member Exchange, Coaching Leadership, General Life Satisfaction and Occupational Well-being through job satisfaction and job strain. The items were rated on a 5-point scale ranging from 1 (totally agree) to 5 (totally disagree) and a high score on each scale indicated a high level of the particular experience. Cronbach s alphas for each scale were Leader-Member Exchange.96; coaching leadership. 0.94; General Life Satisfaction 0.61; Occupational Well-being, job satisfaction 0.89 and job strain Due to limited length of the paper, more precise information on our data and measurement scales is available from authors. 5. Results Linear regression analysis were used for analyzing whether coaching leadership, LMX relationships and general life satisfaction predict job satisfaction and job strain. Due to correlation between LMX and Coaching leadership, separate linear regression analysis were used to analyze how these leadership aspects predicted job well-being. All analyses were adjusted for the effect of age, gender, family/ marital status, supervisor, type of the employment contract (permanent/ fixed-term), length of the employment contract to employer and length of the LMX relationship. Initial analysis revealed no significant interactions between these background variables and job satisfaction and job strain. Therefore, all results presented in this paper are based only on main effects models. Table 3 presents the associations between coaching leadership, LMX, general life satisfaction and job satisfaction and job strain. After adjustment the background variables, coaching leadership, LMX and general life satisfaction predicted higher job satisfaction and lower job strain. General life satisfaction and Leadership (LMX and Coaching leadership) predicted job well-being almost in similar extent. 54

51 Table 3. Coaching Leadership, LMX relationships and General Life Satisfaction predicting Job satisfaction and Job Strain. beta t p-value r^2 chance Job satisfaction 0,203 Coaching Leadership 0,366 4,246 0,000 General Life Satisfaction 0,288 3,657 0,000 0,183 Leader-Member Exchange 0,317 3,632 0,000 General Life Satisfaction 0,337 4,298 0,000 Job strain 0,202 Coaching Leadership 0,408 4,383 0,000 General Life Satisfaction 0,258 3,045 0,003 0,143 Leader-Member Exchange 0,281 2,836 0,006 General Life Satisfaction 0,297 3,339 0,001 To gain more a holistic view of individuals experiences of their working lives, we used cluster analysis, including of both leadership and well-being. Using a K-Means Cluster Analysis, revealed four groups (sig.=,000) within our data. Each group was large enough for statistical analysis, and we also named the groups in order to highlight their typical features. Table 5 presents the means for each group of phenomena in this study. Group one was named we can do this (N=23) and typically this group perceived leadership (LMX and coaching leadership) as excellent and job satisfaction as acceptable. Job strain did emerge to a certain degree within this group of people. Group two was named slaving away (N=18) and featured respondents with very low levels of job satisfaction and high levels of job strain. Their relationship with their leaders was neutral and the leaders were not perceived as coaches. The existence of this group of employees is of course alarming and the organization needs to act upon it. The third group named nine to fivers (N=32), reported their experience of each phenomena in the study, that is both leadership and well-being as adequate. The fourth group (N=31), the happy-goluckies comprised those whose perceptions of coaching leadership, LMX relationships, job satisfaction and manageability of job strain were highest. The quality of LMX relationships was very high and the cluster mean was 4,71. Supervisors were also perceived very much to be coaching (mean 4,42) by this group. Job satisfaction was also very good (mean 4,359 and manageability of job strain was good (mean 4,27). When we focused attention on respondents from a certain group, we did not find that gender, age, family situation, type of employment contract (fixed term/ permanent), length of employment with 55

52 present employer were statistically significant to that relationship. Two variables were found which explained the group composition to some extent. The first and stronger relationship was between group composition and the unit where participants worked. The other relationship was between the group and the length of the LMX relationship. In the last section of this paper, we discuss the findings of this study and draw its conclusions. 6. Conclusions and discussion The contribution of this study is that it looks at the relations between four factors parallelly: the superior s coaching behaviour, the leader-member relationship, general life satisfaction and the job well-being experienced. This study found that 1) good leadership is significantly related to employees experiences of job-related well-being, 2) good relationships between superiors and employees are statistically related to the employees experience of a strong sense of job well-being, 3) coaching leadership is related to good relationships between superiors and employees, and 4) general life satisfaction has a crucial role in job well-being. Even though organizational circumstances, such as leadership, psychosocial work environment etc. are important, these are not the only dimensions affecting individuals experience of job well-being. Four groups stood out and were given names we can do this, slaving away, nine to fivers and the happy-go-luckies. Each of the four types could be found in each of the business units, and led by the same leader. This confirms that both leadership and personal job well-being are experienced individually. The relationships with the same leader vary in a group of subordinates and their connection to the experience of the person s job well-being seems more complicated than the merely linear. This merits further investigation with a larger dataset. To sum up, our research has several practical implications for business: first, developing leadership of supervisors should be important points of reference, even when the aim is to further job wellbeing. Second, when developing leadership, attention should be paid to superior-employee relationships and not just the superiors work, as traditional leadership training usually does. Third, when job well-being is on focus in work places the general life situation of employees should be added to discussion as well as to measurement scales. Our research also has certain limitations. The material in this study is relatively narrow and has a skewed distribution. The results are, however, clear and sufficiently guiding to say that the research should be continued with a larger dataset and different research methods. From the perspective of employees well-being, future research also should take into account individual features. Additionally leaders own job well-being merits further research, because their work has become more challenging with societal development and organizational changes. References Baptiste, N., 2008, Tightening the link between employee wellbeing at work and performance. A new dimension for HRM. Management Decision, 46: Collinson, D., 2005, Dialectics of leadership, Human Relations, 58: Danna, K. and R.W. Griffin, 1999, Health and well-being in the workplace: a review and synthesis of the literature. Journal of Management, 25: Ellinger, A. D. and R. P. Bostrom, 1999, Managerial coaching behaviors in learning organizations. Journal of Management Development, 18: Erdogan B. and J. Enders, 2007, Support from the top: supervisors' perceived organizational support as a moderator of leader-member exchange to satisfaction and performance relationships. Journal of Applied Psychology, 92:

53 Evered, R. D. and J. C. Selman, 1989, Coaching and the art of management. Organizational Dynamics, 18: Gardner, D. and M. O Driscoll, 2007, Professional wellbeing. In I. M. Evans, J. J. Rucklidge and M. O Driscoll (Eds). Professional practice of psychology in Aotearoa New Zealand. Wellington: The New Zealand Psychology Society Inc.; pp Ghazzawi, I., 2008, Job satisfaction antecedents and consequences: A new conceptual framework and research agenda. The Business Review. Cambridge 11(2): Graen, G. B. and M. Uhl-Bien, 1995, Relationship-based approach to leadership: Development of leadermember exchange (LMX) theory of leadership over 25 years: Applying a multi-level multi-domain perspective. Leadership Quarterly, 6: Judge, T. A. and R. J. Locke, 1993, Effect of dysfunctional thought processes on subjective well-being and job satisfaction. Journal of Applied Psychology, 78: Karasek, R. A., 1979, Job demands, job decision latitude and mental strain: Implications for job redesign. Administration Science Quarterly, 24: Kuoppala, J., A. Lamminpää, J. Liira and H. Vainio, 2008, Leadership, job well-being, and health effects a systematic review and meta-analysis. Journal of Occupational and Environmental Medicine, 50: Liden, R. and J. Maslyn, 1998, Multidimensionality of leader-member exchange: An empirical assessment through scale development. Journal of Management, 24: Maslach, C. and S. Jackson, 1981, The measurement of experienced burnout. Journal of Occupational Behavior, 2: Moyle, P., 1998, Longitudinal influences of managerial support on employee well-being. Work & Stress, 12(1): Mäkelä, L., 2009, Women s leader-member relationships during pregnancy and the return to work. Acta Wasaensia. No Vaasa: University of Vaasa. Pollitt, D., 2009, Leadership training gets medical company fit for the future.training & Management Development Methods, 23(4): Schultz, M. L., 2008, Occupational well-being: the development of a theory and a measure. Kansas State University. Dissertation. Schyns, B. and H.-J. Wolfram, 2008, The relationship between leader-member exchange and outcomes as rated by leaders and followers. Leadership & Organization Development Journal, 29: Sosiaali- ja terveysministeriö, 2005, Työhyvinvointitutkimus Suomessa ja sen painoalueet terveyden ja turvallisuuden näkökulmasta. Sosiaali- ja terveysministeriön selvityksiä 25. Helsinki. Viitala, R., 2004, Towards a Theory of Knowledge Leadership. The Leadership & Organization Development Journal, 25: Viitala, R., 2007, Esimiehestä coach. In M. Räsänen (Ed.). Coaching ja johtajuus. Valmentava ote esimiestyössä. Edita. Way, M. and M. MacNeil, 2006, Organizational characteristics and their effect on health. Nursing Economics, 24(2): Whitmore, J., 2007, Coaching for performance. London: Nicholas Brealey Publishing. Wright, T. A. and R. Cropanzano, 2000, Psychological well-being and job satisfaction as predictors of job performance. Journal of Occupational Health Psychology, 5:

54 LEADERSHIP AND THE GENERATIONS WORK-RELATED WELL-BEING Kirsi Heikkilä-Tammi, Sanna Nuutinen, Marja-Liisa Manka and Marjut Mäenpää University of Tampere, School of Management, Research and Education Centre Synergos, FI UNIVERSITY OF TAMPERE, Finland, Our purpose is to shed light on what the members of different generations expect of a good leadership. The preliminary results introduced in this paper are from a questionnaire of a wider research. In this paper we describe how various generations view good leadership and how they can support interaction in this relationship. The results indicate differing needs of various generations: while the generation X values interactive leadership, the generation Y emphasizes flexibility and optimism. Each generation mentions fairness and justness as important aspects of a good leadership. These results are in line with previous research. Keywords: Various generations, relational leadership, well-being at work 1 Introduction The research is motivated by the current situation at the Finnish working life, in which some of the younger employees find themselves as not capable of staying in it for a long time. According to a research conducted in the area (Varma: Odum 2009) one out of eight year old employees believe that after two years, they won t be fit for work. In this research we study into leadership and well-being at work from the various generations point-of-view. It can be stated that growing up in a certain age affects the generation s attitudes and values (Joshi et al. 2010). Generations can be categorized in multiple ways; however, we have divided the generations that are in the working life at the present moment into three categories (cf. Zemke et al. 2000; Purhonen 2008): - The baby boom generation ( ) has a high working morale and for them work has a central role in maintaining self-respect. The principles of leading and the organizational culture are built by this generation. - The generation X ( ) can be described as a give-it-all-to-me-now generation, and the members of this generation value good salaries as well as proper career opportunities and a possibility to educate themselves further in their work. Technology is a substantial part of their life. - The generation Y ( ) is characterized by virtual life as well as various networks. This generation is also called as an Internet generation. 12 It has been found that employees of varying ages have differences in their attitudes towards work: almost two third of 56 year old people agree on the argument that work is the most central area in one s life. In contrast, almost as many under 36 years old view work as not the most central area of life (Haavisto 2010). Furthermore, under 30 year olds consider good leadership more important than the salary level (Nuoret ja johtaminen -tutkimus 2010). One of the leadership challenges is ensuring that the employees of varying ages stay in the working life. The number of disability pensions of under 35 year olds has increased by 40 % from the year 2003 to In this paper anyone born in year 1980 is counted as a member of the generation X and anyone born in the year 1960 is counted as a member of a baby boom generation. This is to ensure that every informant is a member of only one generation. 2 There is also an increasing amount of discussion about the generation Z (1990-), which is entering the working life at the present moment (Tienari 2011). However, no members of the generation Z are represented in this research. 58

55 (TTL 2010) and in 2008, the mean age of the employees entering the disability pension was only 52 years (Hiltunen & Kiviniemi 2009). Leadership means continuing interaction Our view of leadership as an interaction is based on the LMX (leader-member exchange) theory, in which the quality of the interaction between an employee and a supervisor is seen as an important aspect in the formation of the leadership. Mutual trust, respect and reciprocity depict a functioning relationship of a supervisor and an employee. (Yukl 2010.) The quality of the relationship between a supervisor and an employee has been connected by the employees especially with aspects of leadership (as opposed to management): supporting, consulting and delegating (Yukl et al. 2009). The leadership, in which leading human beings is a central concept, has been called transformative and/or shared leadership (empowerment). It has been depicted as a dynamic, interactive process of influencing each other in a group in which the main purpose of the members is to lead each other to achieve the objectives of the group or the organization, or both. The process of influencing often includes working with fellows, and in some cases also affecting upwards or downwards in hierarchy. Shared leadership is widely distributed among the members of a group, which means that there possibly is not any named supervisor. (Pearce & Conger 2003.) The emotional and psychological support seem to advance the shared leadership, which results with the team members feeling valuable and appreciated (Carson et al. 2007). The employees of various generations might emphasize different things as elements of a good interaction. For instance, the work satisfaction of the older employees has been noticed to decrease as a result of an insufficient amount of guidance from a supervisor (Bos et al. 2009). The well-functioning relational leadership between a supervisor and an employee has been noticed to be connected to the employees work satisfaction, which leads to well-being at work (Coglisher et al. 2009). Well-being at work is understood in this research from a wide perspective, meaning that it includes the functionality of an organization, the work community, leadership, personal well-being (work engagement, work ability) and the characters of work (Manka 1999). 2 Objectives In this paper, we present results from a part of a larger research funded by The Finnish Work Environment Fund, in which we ask How a relational leadership can provide for well-being at work and staying in the working life among employees and supervisors from various generations? We find it essential to look for differences between the members of various generations in their expectations from leadership; thus, we seek to answer a question whether or not various generations should be led in differing ways. In this paper we focus on the results of a questionnaire about what is considered as a good leadership and how interaction can be improved in leadership. We approach leadership and well-being at work from the perspective of reciprocity; according to our view, the responsibility of well-being at work and the quality of relationship belongs to both the supervisor and the employees. 3 Methods This research is based on action research, which means that the purpose of the study is to affect and trigger changes in the social practices of a studied community (Robson 2002; Heikkinen et al. 1999). Both qualitative and quantitative methods are applied in this research. In the first phase of this study we conducted a documentary analysis, a survey about well-being at work and personal interviews based on appreciative inquiry (Cooperrider & Avital 2004). A survey about well-being at work is directed to the employees of the participating organizations. The employees were chosen for personal interviews on the 59

56 basis of obtained information and the data from the survey. Results are going to be presented for the participating organizations in workshops, in which the objective is to have the members of the organizations reflect the results. In the second phase of this study group interviews are conducted according to the principles of appreciative inquiry. Also, if necessary, we conduct personal interviews for both supervisors and employees. Through this, we seek to deepen our understanding of the results from the first phase of the research. Moreover, in the group interviews we seek for an understanding about what are the characteristics of the interaction that results with well-being at work. Also, in this phase of the research all of the data collected in the project will be analyzed and drawn together. Finally, all of the results will be reflected together and if necessary, the actions to be taken to improve well-being at work and / or the practices of leadership in the organization are planned for. The empirical data of the research will be collected from three organizations with different challenges in leadership. These organizations are 1) a hospital, institutional care of the elderly, 2) a central hospital, 3) a sewer company. The results presented here are based on the survey conducted in the first phase of the research (spring and summer 2011). In the survey the well-being of the employees, the quality of leadership, the leadership practices, the functionality of an organization and the quality of an individual s well-being at work were studied. 4 Results In total, 333 (59 %) completed surveys were returned to us. The respondents were members of various generations as follows: the baby boom generation ( ) 32 %, the generation X ( ) 48 % and the generation Y (1981-) 20 %. The mean age of the respondents was 43.5 years. Women constituted a majority (81 %), while 19 % of the respondents were men. This bias can be explained by the participant organizations; 85 % of the respondents work in the area of health care (nurses, laborants, doctors), which is traditionally an area dominated by female employees. 16 % of the respondents were in a position of a supervisor. In addition to the multiple choice questions, following open-ended questions were asked: In your opinion, what is the good leadership like? What can you do yourself to help the interaction between you and your supervisor work as functionally as possible? The responses were analyzed data-driven by content analysis. Various entities (e.g. fairness) in the responses were separated and regrouped 3. Almost every response to the first open-ended question included more than just one theme. The responses were classified and eight categories were formed from the first question. Table 1. The categories for the question In your opinion, what is the good leadership like? (n=208) Being just, fair, objective % Listening to and noticing the employee 97 47% Being responsible, taking care of things and solving problems 84 40% Discussing openly and honestly 61 29% Giving feedback, supporting, rewarding 45 22% Respecting, valuing and trusting the employee 44 21% Being precise, assertive and independent, possessing authority 34 16% Standing up for the employee 17 8% 3 This is the reason why we report more grouped themes (n=490) than responses to the questions (n=208). In the table below, the percentage shows the amount of respondents mentioning the theme. 60

57 Treating employees in a just, fair and objective way was seen as the most important element in leadership. Earlier research has found these aspects to be central for well-being at work (Elovainio et al. 2003). Our respondents stated for example: A supervisor has to treat all of the employees equally, but still not to be a friend but a leader. A supervisor should be able to talk about difficult things as well as give positive feedback., A good supervisor listens to employees, and s/he is also understanding and empathetic. S/he treats everyone equally, and does not favor anyone. Almost as many respondents mentioned listening to and noticing the employee and allowing the employee to participate, for example, in decision making, by saying for example: The employees are listened to, issues are dealt with, and if the employees point out some problems, they are taken seriously., Listening. And listening once more. Dealing with things actively., A good leader treats his or her employees equally. A good leader gives the employees enough responsibilities and a possibility to affect the aspects in their own work. Being able to affect one s own work is one of the central prerequisites of well-being at work (e.g. Manka 1999). Furthermore, almost 50 % of the respondents mentioned being responsible, taking care of and solving problems as an important character in a leader. Interaction was addressed in many responses. Totally, three categories approach interaction from different point-of-views: 1) listening to and noticing the employee and allowing the employee to participate, for example, in decision making, 2) discussing openly and honestly, allowing information to reach the employees, and 3) giving feedback, supporting, rewarding. Different emphases can be interpreted from the responses when the respondents generations are taken into consideration. The members of the generation X value open and honest discussion. Both the generation X and the baby boom generation emphasize being responsible, being capable of dealing with things at work and solving problems. The members of the generation Y, who were the youngest participants, as well as the members of the baby boom generation appreciate listening to the employee, taking the employee into consideration, noticing the employee and allowing the employee to participate in the decision making. For the generation X the aforementioned aspects were less important. All groups emphasize being just, fair and objective as characters of a good leader. According to Yukl et al. (2009), the quality of a relationship of supervisoremployee is connected especially to the supervisor s relations-orientation: delegating, rewarding and giving feedback as well as to supporting the employees. In this research, similar elements of evaluating good leadership were found. The second open-ended question in the survey was how the respondents could themselves improve the interaction between the supervisors and the employees. Table 2. The categories for the question: What can you do yourself to help the interaction between you and your supervisor work as functionally as possible? (n=176) Openness and open discussion % Being a good and an active employee 29 16% Honesty, trustworthiness, tactfulness 29 16% Listening to, understanding and respecting the 25 14% supervisor Flexibility and positivity 16 9% Reflecting one s own actions 10 6% No suggestions % Openness and an open discussion are emphasized in the responses: Open discussion, honesty., Relating to a human being openly, respectively and with self-control., Discussing work-related issues openly and 4 Part of the respondents reported that they have no suggestions, due to either a functional or a dysfunctional interaction at their organizations. Because these respondents reported aspects that seemed relevant (e.g. hopelessness), we wanted to include these responses to our data. 61

58 constructively with a supervisor. For the members of the generation X an open interaction seems to have more importance than for the members of the other two generations; on the contrary, it seems that listening to, understanding and respecting a supervisor is not as important for them as it is for the other groups. The youngest respondents (members of the generation Y) emphasize flexibility and positivity more than the other groups. Discussion The results reported in this paper are preliminary and the conclusions are based on the content analysis from each generation s responses; we searched for aspects of a good leadership that the various generations emphasize. It should be noted, though, that the groups were of different sizes: almost 50 % of the respondents were members of the generation X. As a whole, the most often mentioned criteria for a good leadership was a fair, just and objective way of relating to the employees. Our results are parallel to the results of Yukl et al. (2009): various aspects of interaction and the relations-oriented behavior are emphasized in the responses. A listening supervisor as well as reciprocity in interaction (open and honest discussion) seems to be valued. It is also essential that a leader is responsible, takes care of work-related issues and solves problems. These results shed light on the needs of the members of the various generations as related to leadership. For example, the generation X can be interpreted to value more interactive leadership than the younger and the older employees. Furthermore, the older groups seem to value the responsibility and problem solving from the leaders more than the members of the generation Y. Also, each generation emphasizes fairness, justness and objectivity as the most important element of leadership. According to previous research (see Elovainio et al. 2003), these aspects are central for wellbeing at work. A well-functioning interaction is another central aspect (Coglisher et al. 2009), along with possibilities to influence one s own work (Manka 1999), which was also one of the central themes in our data. Moreover, these results uncover those questions we should concentrate on during the research project and further data collection. Finally, the results presented here encourage us to search for differences in the preferences of various generations in what comes to the quality of the interaction. References Bos, J.T., Donders, N., Bouwman-Brouwer, K.M. & Van der Gulden, J.W.J Work characteristics and determinants of job satisfaction in four age groups: university employees' point of view. International Archives of Occupational & Environmental Health 82 (10), Carson J.B, Tesluk P.E. & Marrone J.A Shared leadership in teams: an investigation of antecedent conditions and performance. Journal of Academic Management 50, (5), Coglisher, C.C., Schriesheim, C.A., Scandura, T.A. & Gardner, W.L Balance in leader and follower perceptions of leader-member exchange: Relationship with performance and work attitudes. The Leadership Quarterly 20, (3), Cooperrider, D., L. & Avital, M Constructive Discourse and Human Organization. The Netherlands: ELSEVIER Ltd. Elovainio, M., Kivimäki, M. & Vahtera, J Organizational Justice: Evidence of a New Psychosocial Predictor of Health. American Journal of Public Health 92, (1), Haavisto, I Työelämän kulttuurivallankumous. EVA:n asenne- ja arvotutkimus Taloustieto Oy. Heikkinen, H.L.T, Huttunen, R. & Moilanen, P Siinä tutkija missä tekijä. Toimintatutkimuksen perusteita ja näköaloja. Atena kustannus: Juva. Hiltunen, M. & Kiviniemi, M Katsaus eläketurvaan vuonna Eläketurvakeskuksen tilastoraportteja 5/

59 Joshi, A., Dencker, J.C, Gentz, F. & Martocchio, J.J Unpacking Generational Identities in Organizations. Academy of Management Review 35 (3), Manka M-L Toptiimi: kohti tuottavaa, oppivaa ja positiivista työyhteisöä sekä henkilökohtaista hyvinvointia. Acta Universitatis Tamperensis 668. Tampere: Vammalan kirjapaino. Nuoret ja johtaminen -tutkimus Taloudellinen tiedotustoimisto & T-Media. Tutkimusraportin tiivistelmä <http://www.t-media.fi/wpcontent/uploads/2010/08/nuoret_ja_johtaminen_2010_tiivistelma.pdf> Luettu Pearce C.L & Conger J.A Shared Leadership: Reframing the Hows and Whys of Leadership. Thousand Oaks: Sage. Purhonen, S Johdanto: suuret ikäluokat sukupolvena? In S. Purhonen, T. Hoikkala & J. P. Roos (eds.) Kenen sukupolveen kuulut? Suurten ikäluokkien tarina. Helsinki: Gaudeamus, Tienari, J. & Piekkari, R Z ja epäjohtaminen. Helsinki: Talentum. Robson, C Real world research: a resource for social scientists and practitioner-researchers. John Wiley & Sons. TTL Nuorille työssä tärkeintä on sisältö ja hyvä fiilis. Työterveyslaitoksen tiedote.<http://tyopiste.ttl.fi/uutiset/sivut/nuorille_tyossa_tarkeinta_on_sisalto_ja_hyva_fiilis.aspx _> Luettu Varma: Odum Nuoret uhkaavat syrjäytyä työelämästä. <http://www.odum.fi/tiedote pdf> Luettu Zemke, R., Raines, C. & Filipczak, B Generations at work: managing the clash of veterans, boomers, xers and nexters in your workplace. New York: Amacom. Yukl, G Leadership in organizations. Upper Saddle River: Pearson Education. Yukl, G., O`Donnell, M. & Taber, T Influence of leader behaviors on the leader-member exchange relationship. Journal of Managerial Psychology 24 (4),

60 B1 - COGNITIVE ERGONOMICS & HUMAN FACTORS B1.1 Selecting team situation awareness measures Linda Sorensen Johnstone B1.2 Development and use of digital manikins based on corporate standards Lina Andersson B1.3 Use of phenomenon of operator's localization with respect to working and supporting surfaces in ergonomic design Olga Chernysheva B1.4 The use of kitting to ease assemblers' cognitive workdload Anna Brolin 64

61 Selecting Team Situation Awareness Measures Linda J. Sorensen1 and Neville A. Stanton1 1 Human Factors Integration Defence Technology Centre Transportation Research Group, University of Southampton School of Civil Engineering and the Environment, Highfield, Southampton, SO17 1BJ Background Situational Awareness (SA) role in dynamic performance of teams has established SA as a key area of assessment to improve training, systems and technical design for team work (e.g. Endsley et al., 2003). As a consequence measurement of team SA is crucial. While the significance of SA is generally accepted as an important part of successful team performance, particularly in domains such as safety critical systems and military command and control there remains a lack of consensus with regards to how team SA can be most appropriately captured. 2. Research methods and findings This paper considers measurement of team SA from the perspectives of Shared SA and Distributed SA with regards to the sensitivity of either measure. Two teams of 17 (N=34) were organised in two different command structures; a traditional hierarchy (abbreviated C2) and a fully connected peer-to-peer network (abbreviated Edge). The aim of this study was to compare the ability of each theory to discern differences between the two teams SA when performing an intelligence analysis task. Shared SA has been defined as team SA where the team share the same SA requirements. As such it was assumed that the Edge network would attain a higher degree of Shared SA than the C2 network given that all team members shared the same team roles. Shared SA was considered using the Situation Awareness Global Assessment Technique (SAGAT) and the Situation Awareness Rating Technique (SART). No difference was found, however, between the C2 and Edge network structures in terms of the scores achieved on either SAGAT or SART. Distributed SA was measured using social network analysis and propositional networks (as detailed in Salmon et al., 2009) and a difference was found when considering the findings on these measures. This indicated that the theory of Distributed SA and its measures had the required sensitivity to reveal differences between the two network structures. This theory is therefore considered in more detail by looking at the contribution of compatible SA in the observed teamlevel SA. 3. Conclusion The findings of this study suggest that Distributed SA may hold the key to resolve the remaining disputes with regards to measurement of team SA. 65

62 DEVELOPMENT AND USE OF DIGITAL MANIKINS BASED ON CORPORATE STANDARDS Andersson L 1, Piamonte P 1 and Gink M 1 1. Volvo Technology Corporation Götaverksgatan 10, Göteborg, Sweden In the automotive production industry oftentimes the ergonomic specialist is invited in the process quite late. A wish is to improve the ergonomic work in production process in a more proactive manner. The results reported in this paper are an integral part of a large internal Volvo project called ProVA (Proactive Vehicle Assembly) dealing with ergonomic issues of assembly in production. Of special interest and discussed in this paper is Digital Human Modeling (DHM) used extensively in the automotive industry in both product and production development, in particularly how Volvo worked with DHM. Key words: Digital, Human, Ergonomic, CAD, DHM 1 Introduction In the automotive production industry oftentimes the ergonomic specialist or engineer is invited in the process quite late; merely to take care of the problems in the production process as they occur. A wish is to improve the ergonomic work in production a process in a more proactive manner, i.e. to consider ergonomics early in the process to be able to work preventatively. Regarding methods and tools, the past decades have shown that Digital Human Modeling (DHM) has been used in the automotive industry initially in product development, and lately increasingly as well in production (Badler et al, 1992, Green and Jordan, 1999, and Chryssolouris et al, 2003). It offers a good possibility to perform ergonomic analysis in product development as well as in manual assembly task in the workplace; in both cases without the need of physical models. The Volvo Group is one of the leading suppliers of commercial transport solutions providing products such as trucks, buses, construction equipment, drive-systems for marine and industrial applications as well as aircraft engine components. The Volvo Group also offers its customers financial services (Volvo Group, 2011). Organisationally, the company is organized in product-related business areas and supporting business units (Figure 1), with production facilities in 19 countries and sales activities in some 180 countries. The decentralized organization with its business areas and supporting in-house units offers the scope for proximity to customers and the advantage of utilizing the Group s vast resources (Volvo Group, 2011). 66

63 Figure 1. The Volvo Group comprising of business areas and business units. Being a decentralized organization with its business areas and supporting in-house units offers the scope for proximity to customers and the advantage of utilizing the Group s vast resources. Each production facility is basically autonomous with regards to its operations, complying with local laws and regulations while adhering to Volvo s core values. This relates as well regarding safety, health and ergonomics programs of the production facilities. Owing to the global and widespread nature of the production sites, it was a welcoming effort to have the ProVA project to gather Volvo production personnel responsible in the areas of ergonomics, safety and health. 2 Objectives This paper aims to show the merits of using DHM ergonomics tools in production, especially when such tools based on industry (company) standards on ergonomics. It also aims to show in part on the potential advantages of dynamic simulations. 3 Methods Initially, a network was built and organised comprised of interested individuals or stakeholders within Volvo s different production sites working in the areas of ergonomics and safety. Thereafter, a literature review on the state of the art of ergonomics methods and tools used in the industry were done. This included an internal review and sharing of methods and tools used in the different Volvo production sites across the world. The review was followed by working of selected use cases or case studies on how ergonomics and safety problems were dealt with in the different production site of Volvo. This paper focuses on the methods and results of the use cases, specifically on using Digital Human Modeling (DHM) in ergonomics simulations and analyses of workplace conditions. Use cases were actually different case studies showing how Volvo s different stakeholders worked on ergonomics-related problems and issues in production sites worldwide. Specifically, the cases revealed the benefits and challenges posed by using tools on virtual manufacturing with human simulations as well as other traditional ergonomics and safety methods used at Volvo s different sites around the world. 67

64 Two major cases are presented here involving different assembly work on commercial trucks. The first case involved the use of DHM ergonomics modules already available in the market (DELMIA V5 DHM modules). The other case used an ergonomics software toolbox called ErgoToolkit developed under the European Union (EU) Framework 7 project MYCAR where Volvo was an industrial partner (MyCar, 2011). ErgoToolkit has been developed in VB.NET, integrated with DELMIA V5 DHM, and provides a range of digital tools for ergonomic assessment of human assembly tasks, namely: Postures Definition and Recognition Ergonomic Volumes Recognition Stress Screening Dynamic Simulation Furthermore, the ErgoToolkit was developed based on Volvo s Corporate Standards on Ergonomics , meaning that the ergonomics variables in the toolkit are based on the said company standard. 4 Results and Discussion 4.1. Use case 1: Use of DHM ergonomic modules already available Mounting of the noise shield (Figure 2) and electric parts (Figure 3) during assembly work in a commercial truck cab were simulated and analysed in this case, the traditional way of using Delmia V5 DHMs including the Human modules for ergonomics analyses. In these cases several postural and viewing problems were reported by the workers. So in order to analyse closely and document the specific aspects of the tasks giving discomfort and visibility problems to the workers, ergonomics DHM simulations and analyses were done. For example, Figure 2 illustrated the visibility problem with the task of screwing the nuts of the noise shield. It was difficult to see the nut without first putting the handle of the particular wrench being shown. Furthermore, Figure 3 demonstrated the shoulder extension and reach conditions when mounting the electric parts on the tractor trailer connector. Figure 2. Rear short cab noise shield mounting. 68

65 Figure 3. Mounting electric parts on tractor trailer connector. Thus, these simulations readily showed the reach, postural and visibility situations encountered by the workers and the problems that lie therein. To further quantify the extent of the problems, built-in analysis tools in the DHM ergonomic modules such as RULA (Rapid Upper Limb Assessment, McAtamney and Corlett, 2004); OWAS (Owasko Work Posture Analysis, Karhu et. al., 1977), etc. were tried. Although insightful, these did not specifically reflect Volvo s ergonomics standards. Hence, there was a need for ergonomics modules that deal with more dynamic simulations and that reflect the company s standards on ergonomics Use case 2: Use of ErgoToolkit The ErgoToolkit developed in the MYCAR project was tested in making dynamic simulations of a commercial truck bunk bed assembly and doing ergonomics analyses based on the company s ergonomic standards (MyCar, 2011). Figures 4 and 5 illustrate some highlights of the results of the simulations and ergonomics analyses. By using the different modules in the toolkit, it was easier to quantify the results and relate them directly to the company standards. Repeatability of the simulations was also easier and faster using different worker anthropometrics groups (i.e. 5 th, 50 th, and 95 th percentiles). In the illustrated cases as shown on Figure 4, they helped visualise and document the reach volumes for the small (5 th percentile) and average (50 th percentile) workers doing the same tasks involved in bunk bed assembly. The concurrent flow charts of the reach volumes for the two clearly showed the instances where the red zones (over-reaching) occurred. In short, over-reaching conditions were present for both worker sizes in similar instances or tasks but in different durations owing in large likelihood to their reach capabilities. In these cases, the more dynamic simulations also led to a better and easier understanding on where the problems lie, revealing subtle differences between worker groups depending on the size or type of worker doing the same tasks. 69

66 Figure 4. Bunk bed assembly simulation and analyses. 5 Conclusions Ergonomics assessment requires the availability of objective evaluation tools integrated in the virtual manufacturing process. Tools for performing typical evaluation methods are usually included in CAD product and manufacturing softwares (Dassault, 2011, Siemens PLM, 2011, and Human Solutions, 2011). However, specific tools reflecting or based on ergonomics knowledge of an automotive company may be missing or are independent from the virtual environment. It is quite important to use established ergonomics evaluation methods and integrate them as digital tools into the virtual assembly plant environment but also reflecting the company s ergonomics standards. The use cases above showed how digital human manikins (DHM) in virtual manufacturing with human simulations were used in Volvo s production sites, one using readily-available modules, and another reflecting a company s erg. Both showed their merits as well as problems and challenges were given and discussed. It can be concluded from the cases that the use of DHM and related virtual manufacturing tools in ergonomics simulation and analyses were generally useful in identifying and illustrating the ergonomic problems, documenting them and trying out possible solutions. Furthermore, their usefulness becomes more evident if the tools reflect the company s own ergonomics standards, which are usually the internal bases of the company s level of safety and health. Traditionally, DHM and related tools are most often used in the product development. This study demonstrated their usefulness in production ergonomics as well, especially if based on the company s ergonomics standards or main concerns. Their uses on problems as they occurred and 70

67 may occur in production in early phases have given our ergonomic teams on production sites a good tool to also collaborate with the other colleagues in different production sites. And it has given the teams more insights on the possible benefits of working with DHM tools in early phases of production planning and actual work - how much proactive ergonomics inputs they can give. 6 References Badler, N.I., Phillips, C.B. and Webber, B.L. (1992), Simulating Humans-computer Graphics Animation and Control, Oxford University Press: New York. Chryssolouris G, Karabatsou V, Kapetanaki G. Virtual Reality and Human Simulation for Manufacturing. (2003), CIRP Journal of Manufacturing Systems, 32(6). Dassault Systemes, DELMIA-MHT, (accessed 2011). Green, W.S. and Jordan, P.W. (1999), Human Factors in Product Design: Current practice and Future Trends, Taylor & Francis: London. Human Solutions GmbH, (accessed 2011). Karhu, O., Kansi, P., and Kuorinka, I. (1977), Correcting working postures in industry: a practical method for analysis. Ergonomics, 8(4), McAtamney, L. & Corlett, E.N. (2004) Rapid Upper Limb Assessment (RULA) In Stanton, N. et al. (eds.) Handbook of Human Factors and Ergonomics Methods, Chapter 7, Boca Raton, FL, pp. 7:1-7:11. MyCar (2011), (accessed 2011). Siemens PLM (accessed 2011). Volvo s Corporate Standards on Ergonomics Volvo Group, 2011, 71

68 USE OF OPERATOR S LOCALIZATION PHENOMENON WITH RESPECT TO WORKING AND SUPPORTING SURFACES IN ERGONOMIC DESIGN. Chernysheva O., Moscow State University, A new approach to determination of metric parameters of work places is proposed, above all, for stereotype kinds of activities. It uses a detected phenomenon of operator s localization in objective environment of professional activities. Localization is the primary mechanism of muscle system static work organization, defining metric system of coordinates in which an operator acts. It gives morphology of the main working position as the initial mechanism which defines the value of static load and parameters of muscles dynamic work. Knowledge of the system of coordinates, in which an operator acts, allows to locate operating and control elements in the best way with regard to his body at the early stages of design. Localization, static, dynamic work of muscles, system of coordinates, operator. 1. Determination of metric parameters of a workplace and designed equipment with positions of human factors for optimization of professional activity is one of the most important directions of ergonomics. Solution of this problem is related to use of different criteria and their combinations offered by sciences about human factors psychology and physiology, anthropometry and somatography, etc. Meanwhile the results are not always optimal. This proves incomplete compliance of the applied methods to the set target and necessity to find other ways of its solution. At the faculty of psychology, Moscow State University after M.V. Lomonosov some results were achieved which allow us to speak about an opportunity to use a new approach for design of workplaces which is related to identification of a system of coordinates in which an operator works. The work is based upon psychological analysis of activity developed in Russia. It is mainly related to the names of A. N. Leontiev, L. S. Vygotskoy, P. Ya. Galperin. Analysis of activities was conducted at an industrial facility. Its result was identification of earlier unknown phenomenon one-type psychosomatic localization of workers towards certain element of a workplace. (3) Figure 1 shows localization of 32 workers involved in manufacturing transformer coils with respect to the side surface of a faceplate (А) a significant element of the workplace for them. All of them are located so that the surface drawn through the faceplate goes through the left shoulder joint (figure 2). 72

69 Figure 1 Significance of the faceplate is related to the necessity of performing fine regulating actions by the left hand (Figure 2). Localization of the left shoulder joint with regard to the side surface of the faceplate in the front, vertical and profile planes ensures this accuracy in maximum. Figure 2 Position in space of other operating and control elements marked in figure 1 with points does not influence localization. We named surfaces defining localization of the subject professionally dominating. Somatic localization with regard to them ensures conditions of the best perception of a sensor signal subjectively significant for an operator. In this case this is the kinesthetic signal, but it can be not only kinesthetic, as in our case, but visual, etc. Similar results were obtained during analysis of sewers, cashiers, PC users, etc. In all these types of activities there is localization of an operator with regard to relatively professionally dominating work surface. Safe localization in the course of work is ensured with respective support surfaces. Thus, optimum position of a man at a work place is determined with metric proportion of working and support surfaces. Meanwhile the initial position is linked to localization with regard to dominating 73

70 element and the main working pose is determined with location of the other significant elements of a workplace. 2. Our approach to analysis and design of professional objective environment stems from interpretation of localization phenomenon as forming human activity in space. In addition, if working surfaces create technological conditions of manufacturing the final product, support surfaces provide optimum conditions for implementation of these conditions by a person. Implementation is performed at two levels - static and dynamic. The static level is determined: first, by localization of a person in the workspace, creating a system of coordinates in which the person works; secondly, by position of operating and control elements that create conditions for formation in this system of coordinates, the main working posture. The last one, in its turn, acts as the starting point of dynamic activity - executive movements. The proposed model of metric organization of subject human environment is, on the one hand, taking into account the impact of gravitational forces onto organization of human muscles. They form the balance conditions in the working space and features of distribution of static and dynamic muscle loads in the workspace. On the other hand, psychological mechanisms that provide fine coordination of muscles supporting static and dynamic load of a man, actively interacting with objective world. It is associated with orientation activities that ensure formation of psychosomatic set, which is manifested by localization in space and forming of the main working position. The special features of a psychosomatic mindset are: - outward expression, i.e. it can be observed and interpreted on the basis of behavior analysis. - inseparable connection of psychological and physiological mechanisms of muscle activity that accompany this phenomenon. The best explanation of psycho-physiological nature of this phenomenon can be found in the writings of N. A. Bernstein (1). He identified six levels of muscular system operation structure (A, B, C1, C2, D, E), which are carried by different structures of the developing brain evolution. Higher levels (D, E) provide the most familiar, highly organized voluntary movements. Level B provides human pose activity, i.e. more closely associated with static work of muscles. Level A provides tonic component of muscle activity. Regulation of Level A operation is provided by the most ancient physiological mechanisms and is unstable to rapid changes in head position and the shoulder girdle. Consequently, an essential prerequisite for the effective functioning of man in space is to smooth and reduce the impact of changes in head position and the shoulder girdle. It is localization that ensures implementation of this function. Psychological mechanisms that determine location of a worker with respect to the professionally dominant element of a workplace in objective environment are relation of the meaning and purpose of an activity. An important feature of these mechanisms is that they are determined not by a meaning and purpose given from outside (as necessary), but based on the personal idea of a worker about them (as he understands). 74

71 The role of sense and purpose objective dominant is related to the fact that conscious localization with respect to the purpose provides a minimum deviation of head and shoulder during activities. It provides their metric stability and therefore stability of operation of A level physiological mechanisms. The same localization of all workers in our example suggests that this understanding in the test case was the same. In case of different understanding of meaning and purpose localization of workers will vary, what can affect labor productivity and efficiency. Integrity and consistency of localization is usually supported by the main support surface located in a certain way. Working while standing, a person tends to take a position so that the head and shoulders were such level with respect to the dominant working surface which would provide its best perception in all the three dimensions. Figure 3 shows an example of a bad structural equipment solution. It does not create comfortable conditions for work while standing. In order to see and affect control organs a worker has to work on hunkers. In order to optimize his operation a control panel should be made at a height that would allow to work while standing or sitting. Figure 3 Work in a sitting position besides a support for feet requires also a support for pelvis. Various support surfaces are used for this chairs, armchairs, stools, etc. which the worker put so that to ensure the balance of the body and the optimum position of head and a scapular waist towards the dominant work surface. Inconsistency of location of the dominating element of a workplace defining localization of a person in space, with the other workplace elements, can result in an ugly work position. A good example from this point of view is workplaces of sewer. Figure 4 shows with a thick line a sewer s position on her workplace. 75

72 Figure 4 It is defined by a mismatch between localization of the head and shoulders towards the needle and necessity to influence knee lever A. Its position in space makes remove the chair to the right with regard to the normal position to provide balance. 3. Revealing phenomenon of body localization made it necessary to comply with the position of support and work surfaces with it. As the localization phenomenon is not realized neither by a worker, nor by a designer, this function should be solved by an ergonomist at early design stages. In order to implement this target a vector and coordinates method of evaluation and design of workplaces was developed. (2) The method allows already at early design stages to define the metric position of the dominant element and to comply the position of other significant work and support surfaces with it. Such approach ensures with a high degree of precision psychosomatic comfort of executive activity. The method is based on revealing planes of localization in three-dimensional space and position of other work and support surfaces in zones convenient for a worker. Figure 4 shows a variant of possible correction of a sewer s workplace. In the initial variant of a workplace the foot pedal and the knee lever (A) for lifting foot of a sewing machine, as it was mentioned above, are located considerably more to the right of the localization zone (needle zone) results in the curvature of the spine in the front plane. Displacement of these organs to the left, provides straightened position of the sewer, significantly improves its work conditions. Thus parameters of the pedal and the lever position can be established either individually (which is better), or by the respective anthropometrical deviations of parameters. Thus, at the project stage the preliminary estimation of the operator s localization on a workplace in stereotypic types of activity allows to improve its static (work pose) and dynamic (movements) components of activity by layout design with regards to localization zones at the design stage. 76

73 THE USE OF KITTING TO EASE ASSEMBLERS COGNITIVE WORKLOAD Brolin, A 1,3, Bäckstrand, G 1,2, Högberg, D 1, Case, K 1,3 1 Virtual Systems Research Centre, University of Skövde Skövde, Sweden 2 Research and Development, Swerea IVF, Stockholm, Sweden 3 Mechanical and Manufacturing Engineering, Loughborough University Loughborough, United Kingdom The higher level of product variation in the automotive industry leads to an increasing workload for the assembler that has to search, fetch and assemble all the variants. This puts high demands on the information that is given to the assembler to fulfil the assembly task. This paper describes the impact of information overload and sources, and their influence on the assembler. Through observations conducted in the Swedish automotive industry, the study has shown that the assembly personnel perceive the kit as structured information and that structured kits are able to present distinct information at a certain place to the assembler, which in turn reduces the searching, resulting in decreased cognitive workload. Keywords: Information handling, Manual assembly, Kitting, Stressors 1 Introduction Within the automotive industry, increasing customer demands and requirements, environmental laws and new technology has resulted in a high variant flora of products, and further increases in variety can be expected in the future. The higher level of product variation leads to an increasing workload for the assembler that has to search, fetch and assemble all the component variants. This puts high demands on the information that is given to the assembler to fulfil the assembly task. However, the information systems used in today s assembly are lacking in usability in many ways (Thorvald et al., 2010). When faced with poorly constructed and presented information, the assembler s workload increases due to the fact that they must concentrate on mental sorting and searching for the appropriate information, as illustrated in Figure 1 (Watts-Perotti and Woods, 1999). These external stressors influence the quality of information received by the receptors and the perception of the motor or vocal response. For example, time stress may decrease the amount of information that can be perceived and hence result in a degraded performance. Some of the stressors may also affect the efficiency of processing information (Wickens and Hollands, 2000). Wickens and Hollands (2000) and Bäckstrand et al. (2005) also state that there are connections between stress and error, which further strengthen the aspect that presenting information at the right time, with the right content, in the right layout, in a perceivable way will ease the cognitive workload for the assembler (D'Souza and Greenstein, 2003, Wilson, 1997). 77

74 Figure 1. An illustration of information processing from several sources. Knowledge of human performance can help to support the design of more stress-tolerant interfaces and provide the appropriate information rather than all information to the assembler. One way of supporting the assembler is to use a material supply principle called kitting (Bozer and McGinnis, 1992, Hanson and Brolin, 2011) where the assembler is provided with a kit of components that together contains one or more assembly operations. The kit can be regarded as a carrier of information that complements or even replaces conventional assembly instructions. The benefit, from a cognitive ergonomics perspective, is that the assembler can focus on the assembly process, i.e. issues related to how to assemble, and strongly reduce the attention required for the decision process, i.e. issues related to what to assemble. By narrowing the information search process, can the assembler more easily enter a passive attention mode, in which the assembler subconsciously perceives and processes information. Bäckstrand (2009) states that if one presumes that passive attention draws less energy from a limited pool of resources, one of the goals with information must be to support the assembler in a way that makes it possible to continue working in passive attention mode, where skills and subskills are more or less automatic. A further advantage with kitting is that the assembler only has to search for information at one position and therefore does not have to use extra steps, which potentially stresses the assembler through increased cognitive workload. When using kitting as a material supply principle, the decision of what components the kitting box will contain is indeed just being forwarded to the personnel that will prepare the kitting box. This means that the preparer is in extra need of an information support system that is able to handle the decision of component variants that should be in the kit. Perhaps one can even assume that it is probably easier to automate, or use other systems, to secure the quality of the kit beside the assembly line rather than on it. 2 Objectives and Methods The objective with this paper was to study potential stressors that affect the assembler in performing the assembly task and their effect on quality and productivity. Another objective was to study how these stressors are affected by the introduction of kitting. The methodology used in the study consists of observations and eight semi-structured interviews performed for 30 minutes, face-toface. The interviews were conducted at five different Swedish manufacturing factories within the automotive industry, where the focus of the interviews were on matters related to the provision of 78

75 information to assembly personnel. The interviews were performed with personnel who had been involved in making the decisions to introduce kitting, with personnel who had been involved in the performing introductions, as well as with assemblers and operators responsible for the kit preparation. 3 Results Through the observations and interviews it was found that the assembler was often provided with too much information rather than the appropriate information, i.e. information overload. Wilson (2001) define information overload as: a perception on the part of the individual (or observers of that person) that the flows of information associated with work tasks are greater than can be managed effectively, and a perception that overload in this sense creates a degree of stress for which his or her coping strategies are ineffective. Bäckstrand et al. (2005) and Bäckstrand (2009) state that information can affect productivity, where the amount of information is the main issue and it is possible to conclude that a large amount of information indirectly affects the quality. At many manual assembly work stations information overload is a common sight, as exemplified in Figure 2. In Figure 2 the information on the plastic boards instructs the assembly personnel of what component variant to select and assemble. The experienced assembler usually reads the three last digits of the part number to get the needed information but the novice assembler have to read more, if not all. Mostly, due to that the original necessary information is placed aside, the workers are forced to figure out where information is located and how to access it in the information system. Therefore, information overload places demands on resources such as memory and attention which ultimately increases the cognitive workload for the assembler. Even the experienced worker assembles the wrong component variant due to the similar digits placed on a narrowed space in combination with time pressure. Figure 2. An example of too much information. When considering work environment aspects and its influence on the cognitive workload, the authors have chosen to consider both the information source itself, where explicit information is presented, and the surrounding environment, in where implicit information typically is available, e.g. from the vehicle arriving on the assembly line or similar. From the worker s point of view, an 79

76 information source contains (or is expected to contain) relevant information (Byström et al., 1995). The sources used in today s manual assembly are usually ambiguous and lacking in flexibility (Thorvald et al., 2010). Instructions on a paper sheet are still the most common way of distributing information to the assemblers in today s factory plants, but since the product variants are increasing fast, the support system needs to be more flexible and adaptable. The instructions are usually displayed on white paper with black text and numbers with highlighted odd variants (besides the part number) by inversed text in white with a black box underneath (Figure 3). According to the observations, this way of highlighting is not enough. The assembler desire a more distinguished way of discerning variants. Consequently, the operators sometimes assemble the wrong required parts (i.e. cause assembly errors) in spite of the available information, which ultimately results in an increase in assembly errors. Part number Description Amount Flashers (without speed control) Flashers (with speed control) Keys (model X) Keys (model Y) Bolt Bolt 1 Figure. 3. An example of paper instructions. Computer screens are usually used in the same way as paper instructions, displaying a list of components, except that they are able to display colour and therefore highlight the variants in a more distinguished way. This gives that the assemblers do not have to search in the information system in the same extent as when using paper instruction, and can view the screen from a distance which can both increase quality and productivity (Bäckstrand et al., 2008). Other sources that are being introduced in the factory plants are pick-light systems and pickingvoice systems. Pick-light (picking indication) systems are based on the use of lights that indicate what part to assemble. It is also possible to add a function (photocells) that makes it possible to receive feedback such as the light extinguishes when the component have been picked. The pickvoice system identifies the location of a component by telling the assembler, typically wearing a headset, to go to a specific location and pick a certain amount of certain components. The assembler then verifies by pressing a button. Pick-light and pick voice systems are usually used in combination with kitting to support the preparer, as mentioned before. Using these support systems replaces the need for perceiving the sought required component as well as the searching and fetching for the preparer of the kit. This will not only reduce the stress level for the preparer but will possibly also reduce the cognitive workload. Therefore the interviews gave that the assemblers were positive towards the introduction of kitting. Several assemblers expressed that they wanted to be able to make changes in the presented information easily themselves and not depended on other IT departments, which was the case when using paper instruction. However, the use of computer screens, pick-lights or voice-picking, has increased the autonomy. The assembly personnel also stated that their work was made less demanding, both physically and mentally when introducing kitting. However, for operators picking the kitting boxes no clear instructions existed for how the 80

77 kits should be structured. Since the parts were not fixed within the kit containers, the structure of the kits varied and the assemblers sometimes needed to search within the kits in order to locate a part. This aspect highlights the importance of having structured and defined information for the assembler, as well as for the preparer, whether the information consists of words, images or components. Further, these information carriers all exemplify the possibility of using semiotics to ease cognitive workload. By implementing and using more semiotics, also known as the study of signs (Monö and Knight, 1997) it is possible to affect the way the kitting box is designed and support assembler in performing a correct assembly task. This means that by using the way the components themselves contain and conveys information, signs, to the assembler of how to fulfil the assembly task, it is possible to learn more about, for instance, how the assembler perceives, searches and sort information and alternative ways to design information triggers. The observations also showed that the use of kitting also makes it possible for inexperienced assembly personnel to perform the assembly tasks since they only has to know how to assemble and not what to assemble. However, it is important to underline that kitting is merely a tool for achieving the goal to ease the cognitive workload for the assembler. Another interesting observation from the study was that some companies decided to divide the personnel into picking operators and assemblers which resulted in a decrease in product knowledge, communication problems among the teams and lacking of stimuli. This issue needs to be investigated further in future research. 4 Discussion and Conclusions The aim of the study was to gain knowledge in what stressors that affected the assembler in performing the assembly task and how these stressors were affected by kitting. Through observations the authors have gained knowledge concerning the impact of information overload and sources, and their influence on the assembler. The study has also shown that the assembly personnel perceive the kit as structured information of what components to assemble and that structured kits are able to present distinct information at a certain place to the assembler, which in turn reduces the searching. One problem that many companies are facing is that the factory plants and the assembly stations were not constructed to use kitting from the beginning. This has resulted in more or less temporary support solutions for the assembler, suggesting that knowledge of the assemblers needs for good support systems is poor. Instead the companies have provided the assembler with too much information rather the appropriate information. Another related problem to this is the placement of the kitting box in the work environment, since this consideration both affects ergonomics aspects for the assembler and the efficiency of the logistics. The authors also believe that the factory plants need to start viewing support systems as an investment rather than direct costs, especially due to the increase in product variants. By investing in good support for the assembler it will benefit the quality and productivity, which ultimately results in increased profit. The conclusions from the observations and interviews are that there is a connection between information support and assembly errors, and that kitting provides as a tool for decreasing the stressors such as information overload and how information is presented. These conclusions will be useful in future work that aims on improving the assemblers working situation. 81

78 5 Acknowledgement The authors would like to thank the companies and the assembly personnel participating in the study. 6 References Bozer, Y.A. & Mcginnis, L.F Kitting versus line stocking: A conceptual framework and a descriptive model. International Journal of Production Economics, 28, Byström, K., Murtonen, K. & Järvelin, K Task Complexity Affects Information Seeking and Use. Information Processing & Management 31, Bäckstrand, G Information Flow and Product Quality in Human Based Assembly. Doctoral Thesis, Loughborough University. Bäckstrand, G., De Vin, L.J., Högberg, D. & Case, K Parameters affecting quality in manual assembly of engines. Proceedings of the International Manufacturing Conference, IMC 22, Institute of Technology. Tallaght, Dublin. Bäckstrand, G., Thorvald, P., De Vin, L.D., Högberg, D. & Case, K The impact of information presentation on work environment and product quality: A case study. Proceedings of NES Reykjavik, Iceland. D'souza, M.E. & Greenstein, J.S Listening to users in a manufacturing organization: a context-based approach to the development of a computer-supported collaborative work system. International Journal of Industrial Ergonomics, 32, Hanson, R. & Brolin, A A comparison of kitting and continuous supply in in-plant materials supply. The 4th International Swedish Production Symposium. Lund, Sweden. Monö, R. & Knight, M Design for product understanding: The aesthetics of design from a semiotic approach, Liber. Thorvald, P., Brolin, A., Högberg, D. & Case, K Using Mobile Information Sources to Increase Productivity and Quality. In: Karwowski, W. & G, S. (eds.) Proceedings of 3rd International Conference on Applied Human Factors and Ergonomics. Miami, USA: USA Publishing. Watts-Perotti, J. & Woods, D.D How Experienced Users Avoid Getting Lost in Large Display Networks. International Journal of Human-Computer Interaction, 11, Wickens, C. & Hollands, J Engineering psychology and human performance, New Jersey, Prentice Hall Inc. Wilson, T.D Information behaviour: An interdisciplinary perspective. Information Processing & Management, 33, Wilson, T.D Information Overload: Implications for Health-care Services. Health Informatics Journal, 7,

79 C1: VISUAL ERGONOMICS C1.1 How to avoid visual problems at Visual Display Units (VDU) in office landscapes Magne Helland C1.2 Impact of cardiorespiratory endurance and night vision on work ability Masaharu Kumashiro C1.3 Sorting spectacles for mailmen Hillevi Hemphälä C1.4 Artificial light is just a complement to daylight? Per Nylén 83

80 How to avoid visual problems at Visual Display Units (VDU) in office landscapes Magne Helland and Gunnar Horgen Buskerud University College, Department of Optometry and Visual Science P.O. Box 235, N-3601 Kongsberg, Norway Introduction: In Norway and many European countries there has been a tendency for many companies to move their office locations from buildings with small or single cell offices to office landscapes. This applies in particular for companies with a work force where many employees spend many daily working hours using Visual Display Units (VDU). Such work can be associated with a high prevalence of visual discomfort and to optimize the work conditions and surroundings both work station ergonomics and lighting must be considered. Method: Three prospective field studies were performed following the VDU workers in the three main Scandinavian offices to a telecom company (Alcatel-Lucent) when moving from a location with mainly single cell offices to an office landscape. This was done for 34 workers in Oslo (Helland et al. 2008a), 32 workers in Stockholm (Helland et al. 2008b) and 19 workers in Copenhagen (Helland et al. 2011). In addition to an ergonomically optimized work station design both visual conditions and lighting were taken into consideration. The workers subjective judgment of their visual situation and surroundings were assessed by a questionnaires based upon Visual Analogue Scales (VAS), both before and after, moving into the office landscape. Results and Discussion: The main results from the three studies will be presented and discussed in the oral presentation. One important conclusion from the work is that by careful design and construction of an office landscape with regard to lighting and visual conditions, transfer from small offices may be acceptable from a visual-ergonomic point of view. Some of the main implications can be summarized in these general recommendations for VDU workstations in office landscapes: LCD screens are preferable due to a less contrast reduction compared with CRT screens The general office lighting should be carefully designed regarding illumination, luminance and contrast reduction Venetian blinds should be installed and used to reduce glare from the windows VDU work places should not be placed too close to the windows A gaze direction parallel to the window walls are preferable VDU operators should be offered optometric care and special corrections if indicated References: 84

81 Helland, M., Horgen, G., Kvikstad, T.M., Garthus, T., Bruenech, J.B., Aarås, A., 2008a. Musculoskeletal, visual and psychosocial stress in VDU operators after moving to an ergonomically designed office landscape. Applied Ergonomics 39 (3), Helland, M., Horgen, G., Kvikstad, T.M., Garthus, T., Aarås, A., 2008b. Will musculoskeletal, visual and psychosocial stress change for visual display unit (VDU) operators when moving from a single person office to an office landscape? International Journal of Occupational Safety and Ergonomics (JOSE), 14 (3), Helland, M., Horgen, G., Kvikstad, T.M., Garthus, T., Aarås, A., Will musculoskeletal and visual stress change when Visual Display Unit (VDU) operators move from small offices to an ergonomically optimized office landscape? Applied Ergonomics (Feb 19.) [Epub ahead of print]. 85

82 IMPACT OF CARDIORESPIRATORY ENDURANCE AND NIGHT VISION ON WORK ABILITY Kumashiro Masaharu 1, Higuchi Yoshiyuki 1, Theppitak Chalermsiri 1, Lai Viet 1, Kumudini D.V.G. 1 and Izumi Hiroyuki 1 1. Department of Ergonomics, IIES, University of Occupational and Environmental Health, Japan 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, , Japan A comparative study of work ability evaluated using several physiological functions and WAI showed that the step test results and night vision are physiological functions that are valid criteria in predicting the degree of work ability. Keywords: Work ability index (WAI), Physiological functions, Functional age, Exercise habit 1 Introduction Kumashiro has developed an equation for functional age to establish an evaluation method for functional age based on physiological age in the workplace (Kumashiro, 2000). Examinations of physical capacities included grip strength, trunk extension, vertical jump, standing trunk flexion, closed-eyes foot-balance, jumping reaction time, vital capacity, timed vital capacity, maximum oxygen uptake, diastolic pressure, and systolic pressure. Examinations of visual functions included near visual acuity (at distances of 33 cm and 50 cm); night time vision (visual acuity at both 30 lx, and at under the usual lighting conditions of 750 lx); and accommodation (D). Psychomotor function examinations were developed and have been adopted as one type of performance index. There are six different examinations, all conducted in the form of a game using a computer device. These consist of instantaneous recognition tests, instantaneous decision tests, comparative decision tests, comparative recognition tests, short-term memory test I, and short-term memory test II. The short-term memory tests I and II differ in the presentation of the problem and in the wait time from the moment the problem disappears from the screen until the response. That is, the former is a test of ability to quickly read and memorize information, while the latter evaluates memory retained over a longer period. As a result, four major indices --- (1) 30 lx visual acuity or accommodation as the visual function, (2) recognition time as instantaneous recognition/decision ability, (3) systolic blood pressure as cardiovascular function, and (4) the kinetic functions of standing trunk flexion, grip strength, timed vital capacity, and jumping reaction time --- are suggested as the principal factors used to estimate functional age. The primary statistical method used to develop a functional age formula was principal component analysis using the Varimax method accompanied by Kaiser normalization. (1) Adaptation to workplaces requiring vision: Suitable for workers in office or clerical jobs 86

83 functional age (i) = (-13.06) x (30 lx visual acuity)* + (0.45) x (standing trunk flexion) + (0.035) x (timed vital capacity) + (0.592) x (systolic blood pressure) + (83.33) x (jumping reaction time) (2) Calculation of functional age for workplaces where bodily activity and quickness are required: Suitable for blue-collar or physical-labor jobs functional age (ii) = (-0.75) x (30 lx visual acuity)* + (-1.16) x (standing trunk flexion) + (0.620) x (timed vital capacity) + (-0.05) x (systolic blood pressure) + (123.09) x (jumping reaction time) *The vision data used in these equations, 30 lx visual acuity, is equal to log10 (measured naked-eye acuity under 30 lx lighting) Four major indices (i. 30 lx visual acuity or accommodation as the visual functions, ii. recognition time as instantaneous recognition/decision abilities, iii. systolic blood pressure as cardiovascular functions, and iv. the kinetic functions of standing trunk flexion, grip strength, timed vital capacity and jumping reaction time) are suggested as the principal factors used to estimate functional age. The purpose of this research is to achieve breakthrough development of a program for increased activity to enhance work ability. To attain this goal we have studied the correlation between several physiological function tests, which were employed in an equation for functional age developed by Kumashiro, and the WAI (Work Ability Index). 2 Methods The subjects of the study conducted in March 2011 were 132 male employees working at 4 facilities of a company that designs, develops, and manufactures semiconductors. The subjects were volunteers who took part in a physical exertion ability measurement conducted by the authors as one of the metabolic syndrome prevention monthly activities conducted by the company. The ages of the volunteers ranged from 20 to 59 (37.2±8.7 M±SD). The 5 physiological function measurement items employed in the equation for functional age were 30lx visual acuity, standing trunk flexion, time vital capacity, systolic blood pressure, and jumping reaction time. Further, a step test was added to study cardiorespiratory endurance. These studies were recorded on WAI investigation forms. 3 Results 3.1 Age group and WAI The WAI scores for all age groups were in the good range. The WAI score was highest in the 20s (N = 27) and the range was 40.6±4.5 (M±SD), followed by the 30s (N = 58) 39.9±4.1, 50s (N = 16) 39.8±2.7, and finally 40s (N = 31) 38.9±3.9. However, there was no significant difference in WAI scores among the age groups (p =.450). In the same way, a significant correlation between age and WAI score was not observed (r = -.113). The number of people in this subject group that showed a poor result was 1 out of 132 subjects (WAI score = 27, age = 29, BMI = 26.0, general office employee of the device development department). 87

84 3.2 Relationship between Chronological Age and the 6 Physiological Function Items The correlation coefficient between the chronological age and the 6 investigation items was calculated (Table 1). A significant positive correlation was observed for high blood pressure (r =.282). Conversely, a significant negative correlation was observed for forced expiratory volume in 1 second as percent of FVC (r = -.181). Table 1 Correlation between chronological age and 6 physical function items Pearson s correlation coefficient (r) p-value with chronological age Timed vital capacity lx visual acuity Standing trunk flexion Step test measurement Jumping reaction time Systolic blood pressure Correlation among the 6 Physiological Functions The correlation coefficient range within the 6 physiological functions was to.149 (Table 2). A significant positive correlation (r =.149) was only observed between night vision (Log10) and forced expiratory volume in 1 second as percent of FVC. In contrast, a significant negative correlation (r = -.176) was observed between the ante flexion in standing and the step test results (pulse after 90 sec). These results showed there is no strong correlation among the 6 physiological function examination items. Table 2 Correlation matrix in 6 physical function items (1) (2) (3) (4) (5) (6) (1) 30 lx visual acuity (2) Standing trunk flexion (3) Timed vital capacity (4) Systolic blood pressure (5) Jumping reaction time (6) Step test measurement * p <.1 *p < Search for Physiological Functions that Effectively Improve Work Ability A generalized linear model was studied using the WAI categories as objective variables and the 6 physiological functions as explanatory variables (Table 3). In this GLM analysis, cumulative logit was used as the link function. The GLM Analysis results showed that a significant correlation 88

85 model at the 5% risk rate level (p =.016) was obtained. This shows that the calculated regression expression is effective for predicting the degree of work ability (from Excellent to Poor ). Of the 6 measurement items, there were 2 physiological function measurements that were effective in predicting the degree of work ability. They are the step test measurement result (p =.038) and Log10 night vision measurement result (p =.022). These results mean that a subject with good step test results and/or good night vision has a higher probability of being in the Excellent range. Table 3 Result of Generalized liner model Independent variable 0.02 Step test measurement 6-30 lx visual acuity Dependent variable: WAI category B Standard 95% Confidence interval P-value Error.0126 [ 0.001, 0.051] [-3.050, ] Correlation between the step test and exercise habits ANOVA was used to study the correlation between the step test results and exercise habits as an index of physical strength, which affects work ability (Table 5). The results showed that there exists a difference in step test results depending on the type of exercise habits (strength) (ANOVA p =.040). Persons who incorporated the exercise habits in their daily lives have a high level of cardiorespiratory endurance in comparison with the people who do not have exercise habits. At the same time a Post-Hoc analysis was implemented to study if there is any difference in the physical fitness level depending on the strength of the exercise being performed, but we could not find any significant difference there. However, it is expected that if the sample size is increased, there will be a clear correlation between the physical fitness level and the exercise strength. In addition, based on the results shown in Figure 1, an exercise strength of medium or higher (walking quickly for at least 30 minutes) is required to improve the cardiorespiratory function. 89

86 Step test measurement (Heart rate bpm) Almost none (n=31) Some light exercise (n=25) Light to medium exercise (n=16) Medium exercise (n=26) Heavy exercise (n=31) Exercise Habits Figure 1 Result of ANOVA: Effect of Exercise habits 4 Discussion Many previous studies have shown a relationship between WAI and physiological function. Some of them showed a correlation between WAI and muscle strength (Pohjonen 2001a) or a correlation with aerobic exercise, which is thought to show endurance strength ((Pohjonen 2001a; Bugajska, et al.2005). Regarding the relationship between physical exercise, which is thought to affect physical capability, and WAI, it has been reported that increased physical exercise supports increased WAI (Tuomi, et al. 2004) and that deficient sports or leisure time (Estryn-Behar, et al. 2005) or deficient physical activity will lower the WAI score. Many papers have reported that disorders lower the WAI score. Further, Pohjonen (2001b) reported using an odds ratio adjusted for age that musculoskeletal disorders and psychological symptoms had a great affect on work ability, and similarly, Kiss et al. (2002) reported that they found a correlation between musculoskeletal disorders, cardiac disease, and respiratory disorders and people with a low WAI score, with musculoskeletal disorders being the factor that had the greatest affect. As stated above, many past research results have shown that there exists a correlation between WAI and physiological functions. This research also found a significant correlation between WAI and the step test. The step test is a typical full body endurance test that uses the heart rate as an index. For this reason, the level of full body endurance is considered to have a large impact on work ability. This observation is also supported and inferred from past research results. Therefore, the level of full body endurance can be raised, and correspondingly work ability increased, by implementing a daily regimen of walking up and down stairs, which is inexpensive and simple to do. Also, we recognize that eye function can be one of the main indexes of aging in our common experience of the world. In addition, the correlation between visual problems and work ability is clear, and limited work ability was the most prevalent among those who had difficulties with distant vision (R. Gould, et al., 2008). In the same way, it is well known that night vision has a major impact on work ability. Past reports, however, have little studied the correlation between night vision and work ability. Here, the results of this research studying the correlation between these two factors found that night 90

87 vision has a large affect on work ability. A countermeasure for declining night vision is to increase the surrounding illumination in ones work area. 5 Conclusions The results of this research showed that the step test results and night vision are physiological functions that are valid criteria in predicting the degree of work ability. It is evident that the step test measurement value is equivalent to the value of cardiorespiratory endurance. Thus, an exercise program that mitigates the decline of cardiorespiratory endurance with age along with measures for preserving night vision, such as mitigating eye strain by shielding the eyes from exposure to ultraviolet light, and abstaining from smoking, as well as preventing obesity, which negatively affects these 2 physiological functions, through a daily exercise regimen are important for maintaining and improving WAI. 6 Acknowledgment This research is part of the research commission by the Japan Organization for Employment of the Elderly and Persons with Disabilities (JEED). 7 References Bugajska, J., Makowiec-Dabrowska, T., Jegier, A. & Marszalek, A Physical work capacity (VO 2max ) and work ability (WAI) of active employees (men and women) in Poland: International Congress Series, 1280, Estryn-Behar, M., Kreutz, G., Le Nezet, O., Mouchot, L., Camerino, D., Salles, R.K., et al For the NEXT Study Group. Promotion of work ability among French health care workers: value of the Work Ability Index: International Congress Series, 1280, Gould, R., Ilmarinen, J., Jarvisalo, J. & Koskinen, S., edit, Dimensions of work ability: 82-83, Helsinki Kiss, P., Walgraeve, M. & Vanhoorne, M Assessment of work ability in aging fire fighters by means of the Work Ability Index Preliminary result: Arch Public Health, 60, Kumashiro, M Ergonomics strategies and actions for achieving productive use of an ageing work-force: Ergonomics, 43, Pohjonen, T. 2001a. Age-related physical fitness and the predictive values of fitness tests for work ability in home care work: J Occup Environ Med, 43(8), Pohjonen, T. 2001b. Perceived work ability of home care workers in relation to individual and work related factors in different age groups: Occup med., 51(3), Tuomi, K., Vanhala, S., Nykyri, E. & Janhonen, M Organizational practices, work demands and the well-being of employees: a follow-up study in the metal industry and retail trade: Occupational Medicine, 54(2),

88 Sorting spectacles for mailmen *Hillevi Hemphälä a, Kalev Kuklane a, Chuansi Gao a, Gert-Åke Hansson b and Catarina Nordander b a Division of Ergonomics and Aerosol Technology, Design Sciences, Lund University, P.O. Box 118, SE Lund b Occupational and Environmental Medicine, Faculty of Medicine, Lund University, Box 117, SE Lund *Corresponding author address: Visual requirements are high when sorting mail. The mailmen in this study are sorting standing up at sorting racks with four shelves. When the mailmen are using progressive lenses due to presbyopia, the reading distances while sorting, are incorrect. In order to see the top shelf clearly (distance approximately 40 cm) they have to bend the head backward (extension) and look through the bottom part of the lenses (vulture neck), in order to see the bottom shelf clearly (distance approximately 80 cm) they have to bend the head and upper back forward (flexion) to use the middle part of the lenses. This results in a bad working posture. The purpose of this visual ergonomics intervention study was to evaluate a specific kind of spectacles designed for mail sorting. The spectacles consists of two fronts were the inner front is mounted with lenses for distance and the outer front has work progressive lenses mounted upside down. Twelve mailmen were studied sorting 150 E5 letters with both their private progressive spectacles as well as the specific sorting spectacles. During the sorting the Electromyography (EMG) of the Trapezius muscles and inclinometri was used to measure muscle activity and flexion/extension of head, arms and upper back. The questionnaires used included the mailmen s experiences of light and vision, visual ergonomics, eyestrain, health, and musculoskeletal symptoms. Measurements of lighting conditions were also performed along with eye examinations of the postmen. This study is performed during April-May Most of the result from the intervention is going to be analyzed during the summer of Some of the results from this study will be presented on the NES conference of

89 Artificial light is just a complement to daylight? Per Nylén*, ** and Federico Favero* *Royal Institute of Technology, Stockholm, **Swedish Work Environment Authority, Stockholm Corresponding author address: According to the EU council directive concerning the minimum safety and health requirements for the workplace (89/654/EEG), workplaces must as far as possible receive sufficient natural light and be equipped with artificial lighting adequate for the protection of workers' safety and health. This demand was decided 1989 and has now been implemented as national provisions etc for more the 20 years. The scientific rationale behind the requirement has strengthened over the years. The discovery of the melanopsin receptor more than a decade ago raised the interest for the physiological impact of daylight on the human organism. It was shown that activation of the melanopsin receptor, which results in a decrease in the sleep hormone melatonin, was most effective at wavelengths around 460 nm. It was also shown that the human eye needs between lux of white light to induce a fully effective decrease in melatonin. This knowledge has far reaching implications. Artificial lighting installations in offices and industries seldom produce higher illluminances than 1000 lx and the recommended minimum illluminance for performing visual tasks at office work is 500 lx. Therefore indoor work seems to be performed at insufficient light levels (or illuminances) in order to maintain melatonin levels as low as possible. The probable result is slight fatigue and attacks of sleepiness, symptoms that are not uncommonly reported among indoor workers and e.g. citizens that due to high age related physical handicaps sparsely can leave their flat for outdoor activities The latter group often also complains about sleepiness during day time, and somewhat contradictory, problems to sleep during night time. A possible mechanism for these coupled symptoms is based on the finding that light during daytime promotes the production of serotonin. This molecule is, except many other functions, a precursor for melatonin production within the pineal gland. Living in insufficient light conditions during daytime would thus not only cause sleepiness but also result in lack of substrate for melatonin production and, consequently, sleep disturbance during night time. The melatonin concentration variation over the 24 h cycle seems to be flattened by insufficient illluminance levels during daytime and, in contrast, often by too high levels of light during nighttime due to need to visit the restroom and light pollution from street lights. If the proposed mechanism is true, it might contribute to treatment of sleep disorders, symptoms estimated to be present in about 30 % of the grown up population. According to the high illluminances produced by daylight and its high proportion of wave lengths around 460 nm, the demand for daylight in workplaces seems even further motivated today than 20 years ago. Another motive for increased daylight at work is energy conservation; daylight is an excellent light source that does not consume electricity. There are today methods and commercially available techniques to bring daylight deeper into offices and industries. New architectural configurations should promote the penetration of daylight in buildings and provide access to the beneficial physiological and psychological effects of light and view. Taken together, this paper aim at initiating a discussion about ergonomic and physiological advantages and disadvantages of regarding artificial light mainly as a complement when sufficient daylight is not available at work and at home. 93

90 94

91 D1 - PROMOTION OF HEALTH, SAFETY AND WELLBEING AT WORK D1.1 The relationship between psychosocial working conditions and perceived safety culture for engine room officers in the Swedish merchant fleet Leif Rydstedt D1.2 Effectiveness of work well-being promotions for profitable business Reijo Kangas D1.3 The culture explaining organizational wellbeing Riitta Viitala D1.4 Good work - longer career-project: A pilot stage Veikko Louhevaara 95

92 THE RELATIONSHIP BETWEEN PSYCHOSOCIAL WORKING CONDITIONS AND PERCEIVED SAFETY CLIMATE FOR ENGINE ROOM OFFICERS IN THE SWEDISH MERCHANT FLEET Leif W. Rydstedt 1 & Monica Lundh 2 1 Lillehammer University College (HiL) AHS: unit of psychology Lillehammer, NO; 2 Chalmers University of Technology; Dept. of Shipping & Marine Technology, Gothenburg, SE The purpose of this study was to analyze the relationship between psychosocial working conditions and perceived safety climate onboard the Swedish merchant fleet. Data was collected by a cross-sectional survey. The sample consisted of 640 Swedish employed engine room officers. A strong relationship was found between the psychosocial working conditions and perceived safety climate onboard (R 2 =.204; p<.001). While role conflict and role ambiguity showed a negative association, social support associated positively to safety climate onboard. Job demands and control showed no relation to safety climate. Conclusion: the safety climate onboard is strongly associated to social and relational factors. Safety climate, Role stress, Job strain 1 Introduction The working conditions in the shipping industry have a number of distinct characteristics which may create strenuous working conditions. Work is going on over all 24 hours during the full week, often with extended work shifts and variable work hours. The striving for increased profitability in the shipping industry has led to reduced manning which in turn has been reported to increase work load for the remaining seafarers (Bloor et al., 2000; Hetherington, et al., 2006; Håvold, 2005; Lundh 2010; Wadsworth et al., 2008). A study by Lützhöft et al. (2008) showed that the rapid technological development that has taken place in the shipping industry during the last decade has led changed work tasks, more administrative duties as well as to increased and conflicting work tasks. Apart from disturbed circadian rhythm and stress-related health problems the working conditions onboard have been found to interfere with performance and vigilance and may therefore adventure safety in work and shipping operation (e.g. Hetherington et al., 2006; Håvold, 2005). Several studies have shown that sea-faring is a high-risk occupation with highly elevated risk ratios among sea farers compared to shore-based employees for non-fatal as well as fatal accidents (e.g. Hetherington et al., 2006; Jensen, et al., 2006; Roberts, 2002). A considerable part of the behavioral research on safety issues has been focused on analyzing the impact of the organizational safety climate upon safety performance. Safety climate can be understood as the shared perception and understanding by the work group of policies, procedures and practices related to safety concerns in the organization (Törner, 2010). The central role of safety climate/culture for actual safety performance is well established in the scientific literature (e.g. Håvold, 2005; Seo 2005; Törner, 2010). There are strong empirical evidence for perceived safety climate to be positively related to actual safety performance as well as a negatively related to the frequency of accidents, risky behavior etc (e,g. Seo, 2005; Törner, 2010). In maritime contexts Oltedal and Wadsworth (2010) found safety oriented management style and practices to be related to better safety perception, while high demands for efficiency was associated to a more negative risk perception in the work onboard. Stave et al. (2006) found psychosocial work stress to be a mediator between risk perception and safety activity, where high work stress tended to level out the effects of high risk perception. The 96

93 authors therefore recommended interventions on safety to also focus on reducing work stress. It can therefore be assumed that high psychosocial work stress leads to a worse perceived safety climate. The purpose of the present study was to analyze the relationship between self-reported psychosocial work stress and perceived safety climate onboard the Swedish merchant fleet. 1.1 Generic models for the work-strain relationship Several generic models have been developed to describe and analyze the complex relationship between the psychosocial work environment and the health reactions of the individual by identifying core elements in the work-strain relationship. For this study to well validated models were applied the Role Stress model (Rizzo et al., 1970) and the Job Strain model (Karasek; Karasek & Theorell, 1990). Rizzo et al., (1970, p. 151) defines work role conflict as when the behaviors expected of an individual are inconsistent and work role ambiguity to be present if an employee does not know what he has the authority to decide, what he is expected to accomplish, and how he will be judged Role ambiguity has been claimed to occur when employees are unclear about role requirements and performance standards and role conflict to occur when two or more requirements of an employee s role are conflicting; that is when complying with one role requirement makes it more difficult to comply with another (Jex et al., 2003, pp ). Work role conflict and ambiguity are associated with, for example perceived stress, anxiety, reduced job satisfaction, and decreased job performance (King & King, 1990). The Job Strain model comprises three dimensions of psychosocial working conditions (Karasek & Theorell, 1990). Psychosocial work demand relates to how hard and intense the job holder has to work and includes, for example, time pressure and quantitative workload. Control or decision latitude comprises two distinct but closely related components: task authority reflects the scope of the job holder s authority to make decisions at work, while skill discretion relates to the level and variety of the skill required for the work tasks and the long-term possibilities to acquire new skills in the work role. The third dimension, work-related social support, refers mainly to emotional and instrumental support from colleagues and immediate superiors. The causal relationship between the dimensions of the Job Strain model and a wide range of health outcomes has been firmly validated (de Lange et al., 2003). 2. Method A questionnaire, including in all 129 items, was distributed to all engine crew members affiliated to the Swedish Merchant Marine Officers Association. The sample consisted of in all 1383 machine room engineers of which 731 (54%) returned the completed questionnaire. Almost all participants were men with Scandinavian background, the mean age was about 47 years (Sd = 11.6). The mean time in current position was about 13 years (Sd = 10.5) and their total experience at sea was in average about 24 years (Sd = 12.8). The occupational positions on board were Chief engineer (44.5%), Second engineer (29.5%), Third engineer (14.0%), Electrical engineer (11.5%) and Other (0.6%). All the participants had some form of technical studies beyond high-school level. Job strain was assessed by the Job Content Questionnaire (JCQ) modified for the Whitehall II study (Stansfeld et al., 2000). Demands were measured by four items ( =0.69). Work-related control was measured by 16 items ( =0.77) while work-related social support was measured by ten items ( =0.80). Role stress was measured by a slightly shortened version of the Role Conflict and Ambiguity Scale (Rizzo et al., 1970) from NIOSH Generic Job Stress Questionnaire. The scale consisted of 12 items, - 8 on conflict ( =0.76) and 4 on ambiguity (.78) (http://www.cdc.gov/niosh/topics/workorg/). To measure the potentially confounding effects of Negative Affectivity (NA) the PANAS scale was used with 10 adjectives related to NA (Watson et 97

94 al., 1988) ( =0.85). Safety climate was measured by 12 selected items from an inventory developed by Håvold (2005), e.g. communication about safety issues are good in our company, the shipping company are aware of main safety problems onboard. A Likert type response scale with 5 alternatives, ranging from strongly disagree to strongly agree was used. The alpha coefficient for this scale was For the analyze hierarchic linear regression analysis was used, with the control variables Negative Affect (NA) and age initially entered, while the dimensions of the Job-Strain model and Work Role Conflict and Ambiguity scale were simultaneously introduced in the second step of the equation. 3. Results Table 1. Correlation coefficients for the variables in the study (n = ) Role conflicts - 2. Role ambiguity Demands Control Support Safety climate All correlations p<.01 Table 1 presents the inter-correlations between the independent variables and the dependent variable (perceived safety clime). As could be expected role ambiguity and role conflicts were strongly positively correlated and these two variables were also strongly negatively correlated to perceived control and social support, as well as to perceived safety climate. Perceived social support showed a strong a positive correlation to safety climate. Table 2. The relationships between Role Stress, the DC-S model and Perceived safety climate (N=640) after initial control for age and NA. Linear hierarchic regression analysis. R R 1. Age/ NA.141*.141* 2. Psychosocial working conditions.345*.204* Significant variables in the 2 nd step: -Age.249* -Role conflicts -.139* -Role ambiguity -.174* -Social support.253* *p<.001 The outcome of linear hierarchic regression analysis is shown in Table 2. The control variables age and NA explained a significant part of the variance in perceived safety clime (R 2 =.141; p<.001). As further shown in Table 2 where was strong remaining relationship between the psychosocial working conditions and perceived safety climate onboard ( R 2 =.204; F=39.46; p<.001) even after the effect of the control variables age and NA had been taken into account. As further shown by the beta weights role conflict and role ambiguity showed a negative association, while social support associated positively to safety climate onboard. Job demands and control showed no relation to safety climate. While age was strongly and positively related to perceived safety climate onboard trait NA failed to affect this measure in the final step of the analysis. 98

95 4. Discussion The findings in this study suggest that role stress and social factors are of high importance in understanding the perceived safety climate among the engine officers in the Swedish merchant fleet. While role conflict and role ambiguity associated negatively work-related social support showed a strong positive association to safety climate. On the other hand, neither control nor demands associated significantly to this construct. The strong association between role stress and a negative perception of the safety climate are in accordance with the findings in previous studies on the association between psychosocial working conditions and perceived stress and mental wellbeing (e.g. Agterberg & Passchier, 1998; Rydstedt & Lundh, 2010). Several authors (e.g Bloor et al., 2000; Lundh, 2010; Lützhöft et al., 2008) claimed that that the rapid technological changes, increase administrative work, reduced manning onboard, and increased demands for profitability etc in the shipping industry has led to new and changed work tasks and a potential role overload to the remaining engineers which may contribute to role conflicts as well as to ambiguity. Despite the changed work tasks in the shipping industry the work organization onboard has not been adjusted to the new work requirements (Lundh 2010; Lützhöft et al. 2008). This often results in that the crew has to find less effective alternative strategies to complete their tasks onboard which may further increase conflicts and in risk taking in work (Lundh, 2010). Oltedal and Wadsworth (2010) found that the seafarers reported higher perceived safety when the work was team based. Age turned out as a strong underlying variable, positively correlated to perceived safety climate. This may be explained by greater experience and skills among the older engineers, and with higher age the engineers tended to have more high ranked positions in the work organizations. The relative high average age in this sample correctly reflects the age distribution within the population of engine officers in the Swedish merchant fleet (Transportstyrelsen, 2010). An obvious limitation of the study was the cross-sectional design of study which does not permit any conclusions on causality. 5. Conclusions A major conclusion from this study is that the safety climate onboard the Swedish merchant fleet is strongly associated with social and relational aspects of the work situation between the crew members as well as in regard to the contacts between the crew and the shipping company at large. An import task for future research would be to investigate which type of changes in the work content that crew onboard has faced and how these changes have affected safety perception and safety behavior as well as health/wellbeing. Furthermore, it would be of great importance to evaluate how the social work organization and engineer s skills needs to be adjusted to the changed work content in order to enable them to safely and efficiently carry out their tasks and to handle their work role requirements. 6. References Agterberg G., & Passchier J. (1998). Stress among seamen. Psychological Reports; 83: Arendt, J., Middleton, B., Williams, P., Francis, G., & Luke, C. (2006). Sleep and circadian phase in a ship s crew. Journal of Biological Rhythms, 21, Bloor, M., Thomas, M., & Lane, T. (2000). Health risks in the global shipping industry: An overview. Health, Risk & Society, 2(3),

96 de Lange, A. H., Taris, T. W., Kompier, M A J., Houtman, I. L. D., & Bongers, P. M. (2003). The very best of the millennium : Longitudinal research and the Demand-Control-(Support) model. Journal of Occupational Health Psychology, 8(4), Hetherington, C., Flin, R., & Meanrs. K. (2006). Safety in shipping: The human element. Journal of Safety Research, 37, Håvold, J. I. (2005). Safety-culture in a Norwegian shipping company. Journal of Safety Research, 36, Håvold, J. I., & Nesset, E. (2009). From safety culture to safety orientation: Validation and simplification of a safety orientation scale using a sample of seafarers working for Norwegian ship owners. Safety Science, 47, Jensen, O. C., Sørensen, J. F. L., Thomas, M., Canals, M. L., Nikolic, N., & Hu, Y. (2006). Working conditions in international seafaring. Occupational Medicine, 56, Karasek, R.A., & Theorell, T. (1990). Healthy Work: Stress, Productivity and the Reconstruction of Working Life. New York, NY: Basic Books. Jex, S. M., Adams, G. A., Bachrach, D. G., & Sorensen, S. (2003). The Impact of Situational Constrains, Role Stressors and Commitment on Employee Altruism. Journal of Occupational Health Psychology, 8(3), King, L. A., & King, D. W. (1990). Role conflict and role ambiguity: A critical assessment of construct validity. Psychological Bulletin, 107(1), Lundh, M. (2010). A Life on the Ocean Wave: Exploring the Interaction between the Crew and Their Adaption to the Development of the Work Situation Onboard Swedish Merchant Ships. Dissertation Thesis for Technological Doctoral degree. Gothenburg, SE: Chalmers Technical University. Lützhöft, M., Bohlin, M., & Nodin, K. (2008). Slutrapport från Funktionsbaserad Bemanning: En förstudie. (Final report from Function Based Manning). Lighthouse, Chalmers: Gothenburg, SE NIOSH Generic Job Stress Questionnaire tools/niosh-job-stress-questionnaire.html Oltedal, H. & Wadsworth, E. (2010) Risk perception in the Norwegian shipping industry and identification of influencing factors. Maritime Policy & Management, 37(6), Rizzo, J. R., House, R. J., & Lirtzman, S. I. (1970). Role conflict and ambiguity in complex organizations. Administrative Science Quarterly, 15, Rydstedt, L. W., & Lundh, M. (2010). An Ocean of Stress? The relationship between psychosocial workload and mental strain among machine engineers in the Swedish merchant fleet. International Maritime Health, 61 (3) Stave, C., Pousette, A., & Törner, M. (2006). A model of the relations between risk perception and self-reported safety activity. Occupational Ergonomics, 6, Transportstyrelsen. (2010). Sammanställning av Rapporterade Fartygsolyckor och Tillbud samt Personolyckor i Svenska Handels- och Fiskefartyg 2009 (Compilation of Reported Ship's Accidents, Near- Accidents and Personal Injuries on Swedish Merchant Ships and Fishing Vessels in 2009). Norrköping, SE: Transportstyrelsen. Törner, M. (2010). Bra Samverkan Skapar Säkerhet om Klimat och Kultur på Arbetsplatsen (Good cooperation creates safety about climate and culture on the work site). Stockholm: Arbets-miljöverket. Wadsworth, E. J. K., Allen, P. H., McNamara, R. L., & Smith, A. P.(2008). Fatigue and health in a seafaring population. Occupational Medicine, 58:

97 D1: PROMOTION OF HEALTH, SAFETY AND WELLBEING AT WORK D1.1 The relationship between psychosocial working conditions and perceived safety culture for engine room officers in the Swedishmerchant fleet Leif Rydstedt D1.2 Effectiveness of work well-being promotions for profitable business Reijo Kangas D1.3 T he culture explaining organizational wellbeing Riitta Viitala D1.4 Good work - longer career project: A pilot stage Veikko Louhevaara 101

98 THE RELATIONSHIP BETWEEN PSYCHOSOCIAL WORKING CONDITIONS AND PERCEIVED SAFETY CULTURE FOR ENGINE ROOM OFFICERS IN THE SWEDISH MERCHANT FLEET Leif W. Rydstedt a and Monica Lundh b a Lillehammer University College, AHS, NO b Chalmers Univ of Technology; Dept of Shipping and Marine Technology Gothenburg, SE The central role of safety culture and safety climate for actual safety performance is established in the scientific literature. The purpose of the present study was to analyze the relationship between the psychosocial working conditions and perceived safety culture onboard the Swedish merchant fleet. The sample consisted of 640 Swedish employed engine room officers (99% men, age M=46.7, sd=11.6) that participated in a survey psychosocial working conditions and who had completed all the scales on psychosocial work issues and safety culture. Hierarchic linear regression was used for the data analysis, with a safety scale as the dependent variable. As independent variables age and Negative Affectivity (NA) introduced in a first block as control variables. In the second block the dimensions of the Demand-Control-Support model were introduced simultaneously with scales on role stress and ambiguity. The results showed a strong relationship between the psychosocial working conditions and perceived safety culture onboard (R2=.204; F=39.46; p<.001). While role conflict (=-.14; p<.01) and role ambiguity (=-.17; p<.01) showed a negative association, social support (b=.25; p<.01) associated positively to safety culture onboard. Job demands and control showed no relation to safety culture. While age was strongly and positively related to perceived safety culture onboard the personality trait NA failed to affect this measure in the final analysis. A major conclusion from this study is that the safety culture onboard the Swedish merchant fleet is strongly depending on social and relational factors between the crew members as well as in regard to the contacts between the crew and the shipping agency at large. 102

99 Effectiveness of work well-being promotions for profitable business Kangas, Reijo University of Jyväskylä, Faculty of Sport and Health Sciences 1. Introduction Evaluation of work well-being interventions relates to understanding the processes and relationships between humans and machines. The target of evaluation is to achieve a balance where both economic and health-related aspects are at an optimal level in terms of the perspective of digitalization and humanization. It is an undisputed fact that all business domains have people working with or without automation and machines. Despite machines, or because of their cycle time, people have direct or indirect work well-being problems. Global business and supply chains force both people and machines into the same orbit of searching profitability, but only machines seem to get proper attention: A robot can be functioning or broken and the operations model needs a preventive maintenance program to ensure continuous production. In the case of humans, it is not so clear, whether he or she is broken, suffering some kind of malfunction, reaching a level of reduced output or nearby total collapse, both mentally and physically, but still apparently capable of work. This study concentrates on the problems of profitable work well-being interventions. It is acceptable to create a maintenance program for humans, too, but it must have a positive effect on the business investing in the well-being maintenance programs. The study is based on exercise psychology and it bypasses mechanical safety and environmental improvements of workplace. 2. Objectives and methods The present research uses exercise psychology as its starting point, exploring effective tools to study human sedentary or active behavior and the psychological impacts of exercise, performance at work and leisure time. Combining exercise and work psychology tools together makes it possible to analyze and measure work stress and capability in a reliable way. Exercise psychology has tools to improve interaction skills, working climate, engagement and internal entrepreneurship as a process alike quality management. Moreover, exercise psychology is a way of coaching people in their overall profession, ensuring productivity, quality and profitability. Productivity is one key parameter to prove business profitability and competitiveness. This study reveals some productivity measuring methods of production patterns which have analytical links to work and exercise psychology studying tools. Exemplary employment can be dynamically modeled and measured from both the physiological and psychological perspective. The study is at its early theoretical phase and any research case, production or service processes are yet to be conducted when this abstract was written. 3. References Biddle, S. Psychology of Physical Activity Gettman, L. R. Economic benefits of physical activity Kaman, R. Cost and benefits of an active versus inactive society Warner, K. Economic implications of workplace health promotion programs Mäki-Frantti, P. Henkilöstön työkyky ja toimipaikkojen tuottavuus 103

100 THE CULTURE EXPLAINING OCCUPATIONAL WELLBEING Riitta Viitala, Risto Säntti & Liisa Mäkelä University of Vaasa, Department of Management, P.O.Box 700, VAASA, Finland. Abstract Connections between organisational culture and work well-being are studied through quantitative data gathered from one case organisation. Organisational culture is seen through the interpretative lens of organisational climate, understood to be mainly influenced by internal factors of an organisation. Five different organisational climate types are recognized, and the influence of these on positive and negative work well-being are analyzed in material gathered from one organisation. The data analysis supports the interpretation that organisational climate influences job wellbeing. This again being correlated to the ability to manage one s work load, supports the interpretation, that climates inviting organisation s members to participate, are worth striving towards. Key words: occupational/job wellbeing, organisation culture, organisational climate Introduction A widely proclaimed goal in organisations is to create and support employees job well-being. The practical methods and means used in fulfilling this task are manifold. Thus, many companies nowadays seem put a lot emphasis on physical healthcare and other individual level practices (e.g. those encouraging physical activity) in their published well-being development programs. Occupational well-being is also often considered to be the responsibility of specific individuals (supervisors, employees themselves) or some limited bodies within the organisation (the HR function). We claim that occupational well-being is still often seen too narrowly. In this paper we take a broader view of occupational well-being and discuss its relation to organisational culture. The literature dealing with organisational culture provides a good foundation for an overall understanding of organisational phenomena (Louis 1983). The objective of this paper is to gain deeper understanding wellbeing as an organisational phenomenon. The research question is: What kind of connections can be found between organisational culture and job well -being of employees in a Finnish public organisation?. The data is gathered from one organisation in the public day-care sector. In this paper we define occupational well-being (or job well-being) as an employee s ability to manage his / her daily workload (The Ministry of Social Affairs and Health in Finland 2005:17). The workload management ability is constructed through various issues related to the mental and physical condition of the person in question. These factors are the outcome of a complex system of factors in personality, personal experiences and their interpretation, human relations within the organisation and the micro-culture of the workplace. Job well-being is regularly studied through concepts such as commitment, job satisfaction and work-life balance (Baptiste 2008). There is a lot of research evidence to show that organisational culture effects on job satisfaction, commitment and also work performance (e.g. Deal et al. 1982; Peters et al. 1982; Orpen 1993; Zamanou & Glaser 1994; Harris & Mossholder 1996). In this study, job well-being is studied through stress, cynicism as one dimension of burnout and work engagement. Organisational culture generally refers to an established way of behaving in an organisation and to the values and convictions that determine it (Pettigrew 1979; Schein 1996; 104

101 Hofstede 1998; Fletcher & Jones 1992). It has a harmonizing effect on the activities of a group by creating a common organisational identity, promoting commitment, bringing stability to the social system, and helping the members to interpret the organisation and its environment as well as the relationship between them (Smircich, 1983; Strauss & Quinn : 7). Thus, organisational cultures have been found to develop into different types. For example Quinn and McGrath (1985) have identified four different types: consensual culture, developmental culture, hierarchical culture, and rational culture, Wallach (1983) has named bureaucratic, innovative, and supportive cultures and Bass and Avolio (1996) have described transactional and transformational cultures. For example Jo et al. (1999) noticed in their study that developmental culture had strong and positive association with job satisfaction of the employees, followed by human-oriented culture, while the effect of hierarchical culture was weak and negative. It has been shown that innovative and group-oriented culture promotes employee job satisfaction (Lee & Chang 2008), and consensual culture emphasizes teamwork and values human relations is strongly associated with higher job satisfaction (McDaniel & Stumpf 1993; Mulcahy & Betts 2005; Park & Kim 2009). Additionally it has been shown, that corporate culture of excellence promotes job satisfaction, commitment and productivity (Kangas et al., 1999). Odom, Boxx, and Dunn (1990) found that removing bureaucratic barriers may contribute somewhat to increasing job-satisfaction and commitment, but significant improvement, however, will occur only when positive action is taken to increase supportive and innovative dimensions. The concepts of organisational culture and organisational climate overlap to a considerable extent (Denison 1996). According to Asif (2011) research on organisational culture is concerned with the evolution of social systems over time, while organisational climate focuses on the impact that organisational systems have on groups and individuals. Watkin and Hubbard (2004) define organisational climate as how it feels to work in a particular environment and for a particular employer. It can, however, contain subcultures which may diverge considerably from the culture of the organisation as a whole and various different climates can exist inside one organisation. (Martin & Siehl 1983; Brown 1995; Lok & Crawford 1999). In this study we concentrate on the part of organisation culture resulting from internal factors, often called organisational climate. Litwin and Stringer (1968) define organisational climate as an intervening variable, mediating between organisational factors and motivation tendencies. Many different organisational factors such as structure, leadership, managerial practices, and the decision processes forms a reality which is perceived by the members of the organisation through the filter of the climate. The perceived organisational climate arouses motivation, causes behavior, which again has various consequences for the organisation, e.g. work satisfaction, performance and in this context well being at work. For example Arnez et.al. (2011) report a consistent link in the relationship between organisational climate and employee mental health, and that the organisation s efficiency mediates this relationship. We join Nakari s (2003) view that organisational climate reflects organisational culture, is based on subjective personal interpretations, which are formed throughsocial interaction, and is linked to work satisfaction. 105

102 Methods The data is gathered in via electronic inquiry a communal day-care organisation of approximately 400 employees in spring We included in the analysis 323 responses from the units more than 5 employees from the data of 370. Most of the informants were women (97,2%) with permanent positions (81,1%). First we wanted to see what the statistical relation is like between respondents indicators of job well-being and their opinion of a climate of their unit. The positive side of job well-being was investigated through the concept of work engagement and negative side through cynicism as one central element of burnout and stress. (Figure 1). In overall, distributions were skewed and indicate that both the climate and wellbeing is on a good level in the organisation in general. 3 As an indicator of positive job well-being, Finnish version of Utrecht Work Engagement Scale (UWES) with nine items was used (Schaufeli, Bakker & Salanova, 2006). Responses were given on a 7-point scale from 1 (never) to 7 (every day)(cronbach s Alpha.885). Measuring a negative job well-being was done using part of the Bergen Burnout Inventory (Näätänen, Aro, Matthiesen & Salmela-Aro, 2003; Salmela-Aro, Rantanen, Hyvönen, Tilleman, Feldt, 2010). We used questions measuring cynicism which is one of the three central elements of burnout beside exhaustion and reduced professional efficacy. The Bergen Burnout Inventory (BBI) consists of 15 items with 5 items measuring cynicism dimension. (Cronbach s Alpha.838). Stress was measured using single item question Stress means a situation in which a person feels tense, restless, nervous or anxious, or is unable to sleep at night because his or her mind is troubled all the time. Do you feel this kind of stress these days? This single item question has satisfactory content, criterion and construct validity (Elo, Leppänen & Jahkola, 2003; Elo, Ervasti, Kuosma & Mattila, 2008) The responses were given by five-point Likert-scale. Measuring work climate is based on the five questions from Healthy Organisation Questionnaire (Elo, Ervasti, Kuosma & Mattila, 2008) in which the sum-scale of the climate questions is seen as a part of the psychosocial work environment. In this paper, each item was used as an independent indicator of the organisation s climate. Due to limited length of the paper, more precise information on our data and measurement scales is available from authors. Climate (5 possible types): a. Relaxed and friendlyleppoisa ja mukava b. Encouraging and supportive of new ideas Kannustava ja uusia ideoita hakeva c. Prejudiced and clinging to old waysbiased and traditional Ennakkoluuloinen, vanhoista kaavoista kiinni pitävä d. Strained and quarrelsome Quarrelsome and disunited Riitaisa ja eripurainen e. Tense and competitive, everyone looks after his/ her own best interest and opportunistic Jännittynyt, kilpaileva ja omaa etua tavoitteleva Positive job well-being (Work Engagement) Negative job well-being (Bunout: Cynicism) ( Stress Figure 1. The analysis framework relating job well-being and stress to respondent s opinion of the climate of his/her unit 106

103 The associations were measured using variance analysis on SPSS and tested by using ANOVA. Since significances show only whether there is a statistical connection or not, we used Eta-squared in order to measure the strength of the two variables. It shows the percentage of dependable variable (job well-being and stress) explained by the independent variable (type of the climate). In general, the data revealed statistical connections in between the type of the climate and all the three well-being indicators (see Table 1). The strongest connections are in bold and the weakest are coloured grey. Climate types A, B and E had significant relations to all three well-being indicators. Climate C only had a connection to negative job attitudes and climate D had connections to negative job attitudes and stress. According to the results of the analysis, negative job attitudes and stress are more strongly dependable on the climate than positive job attitudes. Also the positive climate has stronger statistical connections to well-being indicators than the climate types with more negative features. To sum up, our data show that climate types A and B are more negatively correlated with negative job attitudes and stress better than types C, D and E. The strongest relationship Climate (5 possible types): a. Relaxed and friendlyleppoisa ja mukava b. Encouraging and supportive of new ideas Kannustava ja uusia ideoita hakeva c. Prejudiced and clinging to old waysbiased and traditional Ennakkoluuloinen, vanhoista kaavoista kiinni pitävä d. Strained and quarrelsome Quarrelsome and disunited Riitaisa ja eripurainen e. Tense and competitive, everyone looks after his/ her own best interest and opportunistic Jännittynyt, kilpaileva ja omaa etua tavoitteleva Positive job well-being (Work Engagement) Stress Negative job well-being (Bunout: Cynicism) ( 4 is between climate type B (supporting and innovative) and stress: it explains 15.9% of the variance of stress in this sample of 323 day-care professionals. Table 1. Relations between the climate and well-being Positive job well-being Negative job well-being Stress A. Relaxed and friendlychatty and nice Pearson s correlation,215 Sig. =,000 Explains 8,4% Pearson s correlation -,

104 Sig. =,000 Explains 11,3% Pearson s correlation -,389 Sig. =,000 Explains 15,9% B. Encouraging and supportive of new ideassupporting and innovative Pearson s correlation,223 Sig. =,000 Explains 9,8% Pearson s correlation -,293 Sig. =,000 Explains 12,6% Pearson s correlation -,301 Sig. =,000 Explains 10,9% C. Biased and traditionalprejudice d and clinging to old ways Pearson s correlation -,149 Sig. =,045 Explains 2,5% Pearson s correlation,216 Sig. =,001 Explains 4,8% Pearson s correlation Sig. =,236 Explains 1,3% D. Quarrelsome and Strained and quarrelsomedisunite d Pearson s correlation -,139 Sig. =,087 Explains 2% Pearson s correlation 108

105 ,300 Sig. =,000 Explains 9,5% Pearson s correlation,261 Sig. =,000 Explains 7,1% E. Tense and competitive, everyone looks after his/ her own best interest Tense, competitive and opportunistic Pearson s correlation -,149 Sig. =,006 Explains 3,8% Pearson s correlation,264 Sig. =,000 Explains 8,4% Pearson s correlation,290 Sig. =,000 Explains 8,9% Table 1. Statistical connections in between climate type and well-being indicators So far, we have some evidence that these evaluations of individuals have some regularity and we see that the relationships exist between the phenomena measured in the in this study. We can simplify that when a person describes the climate at the workplace as relaxed and friendly chatty and nice or encouraging and supportive of new ideassupporting and innovative, it is less probable that she/he feels negative job-attitudes or stress than those who tell the climate to be prejudiced and clinging to old waysbiased and traditional, strained and quarrelsome quarrelsome and disunited or tense and competitive, everyone looks after his/ her own best interesttense, competitive and opportunistic. However, on this basis we still cannot say much about the perspective of organisational culture in this sample. Therefore we made some extra analysis in order to investigate the differences in organisation climate between the units (Table 2). The data showed that job well-being is to some degree in connection to the unit they come from (positive side with p=0,000, negative side with p= 0,000, and stress with p= 0,01). When analysing the statistical differences in organisational climate type between the units it showed that types D and E are clearly in relation to some specific units. The unit explains 15,9 % of the variance of opinions whether the climate in the unit is quarrelsome and 109

106 disunited and 13,5% of the variance of them concerning its being tense, competitive and opportunistic. Thus, we could speculate that people are more unanimous about the negative features of the climate of their workplace than about the positive ones. Table 2. An unit explaining the climate Sig. Eta Unit explains of the variance A. Relaxed and friendlychatty and nice,072,296 8,8% 5 B. Encouraging and supportive of new ideassupporting and innovative,298,260 6,7% C. Prejudiced and clinging to old waysbiased and traditional C.,065,299 8,9% D. Strained and quarrelsome Quarrelsome and disunited,000,398 15,9% E. Tense and competitive, everyone looks after his/ her own best interest Tense, competitive and opportunistic,001,368 13,5% Table 2. The differences in organisation climate between the units What we are able to say on the basis of this data is that there is a statistical connection between the phenomena on the individual level and on the unit level in one organisation. We can only speculate about the cause-and-effect relationships among the variables of interest. It might also be, that individuals with higher job well-being create a better organisational climate. When analyzing the possible factors for the differences between the units we found that behavior of the leader was strongly in connection with the results. Additionally we noticed that in our case the best unit was a lot smaller than the worst. What might be the effect of the age structure which also differentiates the units? How much these aspects affect the differences still remains unanswered. This study is just a start up for a longitudinal study. Discussion Organisational wellbeing can be seen as a social construct, an outcome of various personal and social factors interacting in a complex systemic manner. Wellbeing is strongly influenced by individual s personal life and his/her ability to make sense of the organisational reality. These intra-personal processes are again influenced by the organisational climate that may 110

107 support the emergence of wellbeing or diminish the probability of this. The climate types A and B can be distinct from types C, D and E in a relevant way. Relaxed and friendly Chatty and nice as well as encouraging and supportive of new ideas supporting and innovative cultures can be estimated to invite members of the organisation in a positive way to participate, to have a say in matters of relevance, to participate in building the organisation s climate. Climate types C, D and E can be estimated to be more uninviting to dialogue, to support withdrawal from organisational discussions. Our data seems to support the interpretation that organisational climate influences job wellbeing. Climate types A and B can be expected to produce a higher level of well being (in terms of less negative job attitudes and stress). Taken that job wellbeing and ability to manage one s work load are by definition related, makes it possible to conclude that chatty and nice as well as supportive an innovative organisational climates provide a better opportunity for winwin settings for all organisational actors. The focus of our interest in this paper has been wellbeing influenced by the external reality of an employee. What will be of future interest is to dig deeper into ways how the members of an organisation experience and interpret the reality at the work place in different ways. From this angle wellbeing can be seen to be related to the capacity of the members of an organisation to handle factors related to wellbeing at conceptual level. Certain metacompetences especially systemic and dilemma focused thinking are expected to be relevant. Organisational climate influences in an overwhelming way how this kind of thinking is supported within an organisation. References Asif, T. (2011), Estimating the impact of Denison's (1996), What is the difference between organisational culture and organisational climate? A native's point of view on a decade of paradigm wars. Journal of Business Research, 64:5, Baptiste, N., (2008), Tightening the link between employee wellbeing at work and performance. A new dimension for HRM. Management Decision, 46: Bass, B. M. & Avolio, B. J. (1993), Spring). Transformational leadership and organisational culture. Public Administration Quarterly, 17: 1, pp Brown, A. (1995), Organisational Culture. London: Pitman. Deal, T.E. & A.A: Kennedy (1982). Corporate Cultures: The Rites and Rituals of Corporate Life. Reading, MA: Addison-Wesley Publishing. Denison, D.D. (1996). What is the difference between organisational culture and organisational climate? A native s point of view on a decade of paradigm wars. Academy of management Review, 21:3, Elo, A-L., Ervasti, J., Kuosma, E. & Mattila, P. (2008). Evaluation of an Organisational Stress management Program in a Municipal Public Works Organisation. Journal of Occupational Health Psychology. 13: 1, Elo, A-L. Leppänen, A. & Jahkola, A. (2003). Validity of a single-item measure of stress symptoms. Scandinavian Journal of Work, Environment and Health, 29, Fletcher, B. and F. Jones (1992), Measuring organisational culture: the cultural audit, Managerial Auditing 111

108 Journal, 7:3, Harris, S. G. & Mossholder, K. W. (1996), The affective implications of perceived congruence with culture dimensions during organisational transformation. Journal of Management, 22, Hofstede, G. (1998), "Identifying organisational subcultures", Journal of Management Studies, 35, Kangas, S., Kee, C.C. and McKee-Waddle, R. (1999), "Organisational factors, nurses' job satisfaction, and patient satisfaction with nursing care". Journal of Nursing Administration, 29:1, Lee, Y-D & Chang, H-M (2009). Relations between Team Work and Innovation in Organisations and the Job Satisfaction of Employees: A Factor Analytic Study. International Journal of Management, 25: 4, Litwin, G. H., & Stringer, R. A. (1968). Motivation and organisational climate. Harvard Business School. Lok, P. and J. Crawford (1999), The relationship between commitment and organisational culture, subculture, leadership style and job satisfaction in organisational change and development, Leadership & Organisation Development Journal, 20:7, Louis, M.R. (1983), Organisations as culture-bearing milieu, in: Pondy, L.R., Frost, P.J., Morgan, G. and Dadridge, T.C. (Eds.), Organisational Symbolism, Greenwich: JAI Press. Martin, J. and C. Siehl (1983), Organisational culture and counter-culture, Organisational Dynamics, 12, McDaniel, C. and Stumpf, L.(1993), "The organisational culture: implications for nursing service". Journal of Nursing Administration, 23:4, Mulcahy, C. and Betts, L. (2005). "Transforming culture: an exploration of unit culture and nursing retention within a neonatal unit". Journal of Nursing Management, 13:6, Nakari, M-L. (2003). Työilmapiiri, työntekijöiden hyvinvointi ja muutoksen mahdollisuus.jyväskylä studies in education psychology and social research 226. Näätänen, P., Aro, A., Matthiesen, S. B., & Salmela-Aro, K. (2003). Bergen Burnout Indicator 15. Helsinki: Edita Odom, R.Y., Box, W.R. and Dunn, M.G. (1990). "Organisational cultures, commitment, satisfaction, and cohesion", Public Productivity & Management Review, 14, Orpen, C. (1993), The Effect of Organisational Cultural Norms on the Relationship between Personnel Practices and Employee Commitment, The Journal of Personnel Psychology, September, Park, J-S &, Kim T.T. (2009). Do types of organisational culture matter in nurse job satisfaction and turnover intention? Leadership in Health Services, 22:1, Peters, T. and Waterman, R., (1982).In Search of Excellence: Lessons from America's Best Run Companies, Harper & Row, New York, NY, Pettigrew, A.M. (1979), On studying organisational cultures, Administration Science Quarterly, 24, Quinn, R.E. and McGrath, M.R. (1985), "The transformation of organisational cultures: a competing values perspective", in Frost, P.J. (Ed.), Organisational Culture, Sage Publications, Newbury Park, CA. Salmela-Aro, K., Rantanen, J., Hyvönen, K., Tilleman, K. & Feldt, T. (2010). Bergen Burnout Inventory: reliability and validity among Finnish and Estonian managers. Int Arch Occup Environ Health DOI /s Schaufeli, W. B., Bakker, A. B. & Salanova, M. (2006) The measurement of work engagement with short questionnaire. A cross-national study. Educational and Psychological Measurement. 66, Schein, E.H. (1996), Culture: The Missing Concept in Organisation Studies, Administrative Science Quarterly, 112

109 June, Shaw, P. (2002) Changing conversations in organisations. A complexity approach to change. Oxon: Routledge., Smircich, L. (1983). Concepts of Culture and Organisational Analysis, Administrative Science Quarterly, September, Strauss, C. and N. Quinn (1997), A Cognitive Theory of Cultural Meaning, Cambridge: Cambridge University Press. The Ministry of Social Affairs and Health in Finland, 2005:17. Wallach, E. J. (1983). Individual and Organisation: The Culture Match. Training and Development Journal, 37, Watkin, C. and Hubbard, B. (2003). Leadership motivation and the drivers of share price: the business case for measuring organisational climate. Leadership & Organisation Development Journal, 24: 7/8, Zamanou, S. & S.R. Glaser (1994), Moving Toward Participation and Involvement. Group & Organisation Management, December,

110 Good Work Longer Career project: A pilot stage Ilmarinen Juhani, Huuhtanen Pekka, Louhevaara Veikko, Näsman Ove Juhani Ilmarinen Consulting Ltd, Pekka Huuhtanen Consulting, Myontec Ltd, Mediona Ltd and The Archipelago Academy for Well-being at Work Introduction Good Work Longer Career project ( ) is based on the collective agreement between the Technology Industry and Metalworkers Union supplied with all relevant parties. A good work content, environment and organization promote work ability and workplace well-being which are also affected by individual resources in terms of health, capabilities and professional competence. Ageing reduces work ability and workplace well-being with a large individual variation. Both work ability and well-being can be developed with multi-factorial programs including both work-related and individual measures. The development of work ability and well-being has also a positive impact on the productivity, profitability and the quality of work as well as the sickness absenteeism and premature retirement. Most enterprises, which have invested both economical and human resources in the promotion of work ability and well-being, are satisfied. Objects This paper focus on the pilot stage of the Good Work Longer Career project in It has the following objects: 1) To train practitioners into the pilot enterprises for the implementation of the methods and developmental processes of the Good Work Longer Career project, and 2) To evaluate the outputs and feasibility of the implemented methods and developmental processes in small- and medium-sized and large enterprises. Methods The methods and processes implemented in the pilot enterprises are based on the theoretical framework of the Work Ability House. The sample of the pilot stage consists of 20 different sized enterprises in the Finnish technology industry. The methods trained and used are the Personal Radar and Company Radar. At the individual- and enterprise-level the objects and needs for developmental measures are identified and prioritized with the Personal and Company Radar, respectively. The final prioritization and agreement on the objects and measures are completed in the project team of each pilot enterprise which also follows the realization and outputs of developmental measures. Results According to the preliminary results and experiences from 5 pilot enterprises the developmental methods and processes based on the Work Ability House are feasible after the training period of one day. The developmental objects can be identified and prioritized with the use the Personal and Company Radar. The objects requiring immediate developmental measures seem to relate to the work in general, values, motivation and collaboration. The identification and prioritization of the developmental objects is a sensitive process which firstly must be supported by an external advisor. 114

111 Conclusions The methods and developmental processes of the Good Work Longer Career project seem to be feasible after the training period of one day. The developmental objects can be identified and prioritized with the methods, and they help to gain the beneficial collaboration and agreement between the different personnel groups in the enterprises. 115

112 E1: SOCIAL & HEALTH CARE E1.1 Choice of course contents and teaching methods used in teaching physiotherapy Paula Kärmeniemi E1.2 Long-term psychosocial stress and work characteristics among shift-working nurses Kati Karhula E1.3 Finnish nurses' work conditions in patient transfers- occupational safety inspections Kati Karhula E1.4 Procurement demands, a management strategy for sustainability Ann-Beth Antonsson 116

113 Choice of course contents and teaching methods used in teaching physiotherapy Kärmeniemi Paula Finnish Institute of Occupational Health, Helsinki, Finland Choice of course contents and teaching methods used in teaching physiotherapy 1. Introduction Speech helps establish a common context and common understanding in social situations, and, in teaching situations, teachers build a common social reality with their students through their verbal interaction with them. In this study, discourse analysis was used to examine both the interaction between teachers and their students during the teaching of physiotherapy and the rhetorical and responsive means of speech used in these situations. The purpose was to determine who chooses the teaching contents and how these contents are chosen. In the traditional teaching paradigm, teachers use their expertise to choose the contents of their courses. 2. Objective The purpose of this study was to gain insight into the teaching discourse used in teaching physiotherapy in universities of applied sciences. 3. Material and methods The data consisted of five videotaped physiotherapy teaching sessions, stimulated recall interviews with physiotherapy teachers, and the teachers written teaching plans. The data were collected from three Finnish universities of applied sciences during the spring of A qualitative research method was used, and the theoretical framework was founded in both social constructionism and discourse analysis. Discourse analysis was used for the data analysis, which was primarily targeted towards rhetorical speech methods, but videotapes of the teaching sessions were also analysed on the basis of responsive relationship themes. 4. Results The analysis of the data identified several defining influences on the choice of the course contents. On the grounds of these defining influences, the following four discourses were found in the teaching discourse used in the teaching of physiotherapy: expert power, teacher choice, student demands, and organisation demands. The teachers built active discourses using both convincing and challenging rhetorical means, the central rhetorical means being the category of the rights of the speaker, as the teachers used their position as an expert as a rhetorical means. 5. Conclusion In this study, the teachers controlled the choice and definition of the teaching contents of the physiotherapy courses. The educational methods, relationship positions, and the use of power, 117

114 as well as the division of responsibility in the teaching situations, exemplified traditional education. These results indicate that the educational methods used for teaching physiotherapy need to be developed and changed in order to meet the challenges of the future in the teaching of physiotherapy. The development should not only be directed towards physiotherapy education, but also towards all of the contexts involved in physiotherapy work. 118

115 Long-term psychosocial stress and work characteristics among shift-working nurses Karhula Kati & Puttonen Sampsa Human Factors at Work, Finnish Institute of Occupational Health, Topeliuksenkatu 41a A, Helsinki, Finland, 1 Objective Several factors may increase the workload of health care professionals. Their work often consists of high demands coupled with poor control over their own work. They also often have irregular shift-work, and their average age is increasing. The aim of this study was to explore the connection between long-term job strain and work characteristics among shift-working female health care professionals. 2 Method The subjects consisted of 97 shift-working female health care professionals (mainly nurses, midwives and nursing assistants), with an average age of 47.3 years (range 31-60). They were recruited from the Finnish public sector cohort study. They worked mainly in medical-surgical, intensive care/emergency, gynaecology or geriatrics wards. Based on the 2008 survey results, wards belonging to the highest or lowest job strain quartile in Karasek's model were identified. The participants evaluated their own job strain as high or low in the ward in which they worked. The survey data collection was carried out via internet-based surveys and three-week sleepwake rhythm was measured using Actiwatch A7 actigraphy. The statistical analyses were conducted by SPSS using Fisher's exact test. 3 Results High and low job strain groups did not differ from each other with respect to age, shift-work experience, stressful life events, family care-giving responsibilities or sleep length. However, there were various statistically significant differences in work characteristics between the stress groups: the subjects classified as belonging to the high job strain group more often reported too much work due to insufficient staffing and that the amount of work was distributed less equally. They were also required to work at high pace, work overtime and take part in complex problemsolving and decision-making. In the high stress group, work was more often physically demanding and inessential tasks took up time from essential work tasks. The only item in which the job strain groups did not differ was the risk of armed violence, which was small in both stress groups. 4 Conclusion Long-term job strain is connected with various negative work characteristics. Job strain is common especially in wards in which the employees consider that they have too much work to do and have a physically demanding job. Adequate staffing in health care settings is important for controlling workload. 119

116 Procurement demands, a management strategy for sustainability Antonsson, Ann-Beth IVL, Swedish Environmental Research Institute and KTH, Royal Institute of Technology 1. Introduction During the last decades, business has implemented a strategy of outsourcing, downsizing and concentrating on core business. A consequence of this development is an increased use of subcontractors. In the procurement process and when contracting subcontractors it is obvious that an important aim is to reduce the costs for the services purchased. This may lead to pressed prices and competition from unserious businesses that do not pay taxes etcetera. As a consequence the available time and the money needed to provide for good working environment conditions may be limited or nonexistent, which may lead to deteriorating working environments. Problems of this kind are known in for example cleaning enterprises and asbestos stripping enterprises. 2. Objectives To understand the prerequisites for working environment demands in procurement and develop procurement demands that secure good working conditions when engaging subcontractors for cleaning or for asbestos stripping. 3. Methods Interviews were made with cleaning enterprises and companies and organisations that engaged cleaning enterprises. The interviews dealt with the attitude towards procurement demands and the possibilities and limitation of including working environment in the demands. Based on the interviews and adapted to the legislation about public procurement, and also based on thorough knowledge about the working environment problems in cleaning and asbestos stripping including measures required to provide a safe and good working environment, procurement demands were developed. 4. Results The interviews provided a good understanding of how procurement demands can and cannot be used on a purely voluntary basis in Swedish companies. Procurement demands have been developed and published and will be presented at the conference. In discussions with the entrepreneurs and their customers, there is an interest in using the procurement demands. Several entrepreneurs inform about the demands on their own web pages. 5. Discussions and conclusions Procurement demands is an interesting strategy that can be used to support good working environments in a modern business context. Further research on the formulation, use an effect of procurement demands relating to the working environment is needed. 120

117 2nd Parallel Sessions Monday September 19, :10 16:50 121

118 A2: MANAGEMENT AND DEVELOPMENT FOR SUSTAINABILITY A2.1 Leader assimilation and the development of leader-member exchange Hilpi Maya Rybatzki A2.2 Human factors in maintenance for a sustainable management of built environment Erminia Attaianese A2.3 The human component of Sustainability: a study for assessing energy efficient construction blocks Erminia Attaianese A2.4 Interviews with employees reporting work-related injuries as the basis for intervention Ann-Beth Antonsson 122

119 THE LEADER ASSIMILATION AND THE LEADER-MEMBER EXCHANGE DEVELOPMENT PROCESS - A LONGITUDINAL CASE STUDY Rybatzki, H Department of Management, University of Vaasa The aim of this study is to increase our understanding in the processes by which the new leader adapts to a new organization and makes a successful leader transition as well as develops interpersonal relationships. The data was collected as interviews (N=21) conducted in one organization on the new leader and the subordinates. The main finding of the study is the important relationship between the leader assimilation and the development of the Leader-Member Exchange. To conclude, the LMX relationships and learning the organization, their tasks and role, the new leader gets assimilated. Keywords: Leader assimilation, Leader- Member Exchange, LMX 1. Introduction When new member enters to an organization, they have to adapt to and socialize quickly. This is especially important when the new member is appointed to a managerial position, since the success or failure in leader transition has an impact on both the career of the new leader and the organization they are entering (Burke & McKeen 1994: 16). One possible viewpoint of socialising and adapting is the process of organizational assimilation, which can be perceived as an integration process between the new member and the organization (Jablin 2001; Myers & Oetzel 2003). The process of building interpersonal relationships can be seen to have a paramount influence on assimilation of a newcomer. Through interpersonal relationships, the organization with its formal and informal systems is acquired, and the organizational reality is being built. One important aspect of assimilation is the information seeking of the newcomer, and the best way to attain information is through interpersonal relationships (Miller & Jablin 1991). The LMX- theory focuses on the individual relationships between the leader and the subordinates, which are constructed on the basis of mutual interaction and exchange (Danserau, Graen & Haga 1975; Van Breuklen, Schyns & Le Blanc 2006). The aim of this study is to increase our understanding in the processes by which the new leader adapts to a new organization and makes a successful leader transition as well as develops interpersonal relationships. The study aims to identify dimensions and occurrences that have an effect on the leader assimilation and the development of interpersonal relationships. 2. The development of the leader assimilation and the LMX In the study the organizational assimilation is considered as a reconciliation of an individual and an organization (Myers & Oetzel 2003). Assimilation is considered as integration, based on interaction between an individual and an organization, and through which an individual is socialized into an organization more quickly and effectively. Successful assimilation leads to a situation in which the individual 123

120 and organization assimilate together. Assimilation should be perceived as a person-organization-fit where both units are fitted together. (Hess 1993; Jablin 2001.) The individual assimilation begins with a proactive socialization stage, which usually starts when the newcomer has their first contact with the company (Hess 1993: 199; Jablin 2001: 743). There are two important aspects of the anticipatory stage for a newcomer; the first is to set expectations, and the second is to start learning the organizational culture through the communication prior to entry. Communication and information sharing are important factors when forming expectations, since the parties develop an image of each other and organizational roles through communication. (Jablin 2001: 753.) As the newcomer enters the organization, they start to build up an image of the organization and its culture as well as the people working there and the role that is expected of the newcomer by seeking information. The information is mostly acquired through interpersonal links in organization in this stage of assimilation. (Hess 1993: 200.) Learning from others through informative interaction is an essential aspect of assimilation of the new leader. As the informal communication and interaction is a crucial factor in the assimilation process, the interpersonal relationships between the new leader and their subordinates cannot be ignored when examining the assimilation of the new leader (Miller & Jablin 1991; Manderscheid & Ardichvili 2008). The interpersonal relationships are examined through the LMX theory. The Leader-Member Exchange (LMX) theory describes the relationship, its quality and characteristics, and exchange between a leader and their subordinate as being the construct of leadership. The relationship and the exchange are individual and diverse between a leader and different subordinates (Dansereau et al. 1975; Liden & Maslyn 1998). In the LMX theory the interpersonal relationships are perceived as being built on the characteristics and traits of both parties of the relationship (Scandura & Lankau 1996: 243). Moreover, the LMX process can also be identified as a developmental process by which the parties learn about each other over time (Bauer & Green 1996). The LMX relationships are assessed on extent of the interaction present in the relationship, exchange between the parties, and the relationships can be divided into high-quality relationships (in-group members) and low-quality relationships (out-group members) (Liden & Graen 1980: 452). Mutual trust and personal relationship are defining features of high-quality relationships as well as high respect and appreciation. In addition, there is a lot of social exchange in those relationships. Social exchange is usually voluntary and the relationships include high levels of trust. The relationships that embody social exchange are usually constructed on personal engagement and obligation. These qualities can be quite low in the beginning of the relationship but grow during the development process (Dienesch & Liden 1986; Sparrowe & Liden 1997). The LMX relationships are perceived as developing quite fast and remaining stable over time (Bauer & Green 1996) As the LMX relationship develops, the process must be seen as reciprocal and interactive with the mutual interaction as the main component (Van Breuklen et al. 2006). The LMX relationship and the roles of the parties can be perceived as developing through the reciprocal exchange and interaction (Bauer & Green 1996: 1558). A conclusion can be drawn, that one important thing for a new leader during the organizational entry is the informative communication. Through the conveyed information they can learn the organization and the ways of action, and eventually be assimilated into an organization (Miller & Jablin 1991; Ostroff & Kozlowski 1992). The interaction and communication are crucial for the new leader, as well as creating links to the organization (Downey 2002). With the interpersonal relationships the new leader will learn the informal information that is vital for the assimilation process (Hess 1993). The LMX relationships are also highly based on mutual exchange and interaction between the parties (Fairhurst & Chandler 1989). 124

121 3. Methods This study is conducted as a case study. The case study for this research is done by using the single-case study with embedded design. The aim is to understand the complexity of one case and thus expand or rewrite some of the present believes and theories. The study is either intrinsic or instrumental and done by combining descriptive and explanatory case study methods. (Eriksson & Koistinen 2005; Yin 2003.) Two rounds of interviews were conducted for the new leader and for the selected subordinates. First the subordinates were interviewed prior to the entry of the new leader, and their expectations and hopes towards a forthcoming leader were determined. Then prior to entry, the external facilitators had a meeting and coaching session with the new leader to help them to get to know the new subordinates and the hopes and expectations they had. The leader was then interviewed after five months, and for a second time approximately eight months after the entry. The selected subordinates were interviewed for a second time at the same point in time, eight months after the organizational entry and their thoughts and feelings of a new leader were examined. There were total of 21 interviews done during this study. The data was collected using semi-structured interviews with the subordinates and theme interviews with the leader. The interviews with the leader had some narrative features and the empirical findings are represented in a stage model using a storytelling form of description. 4. Results The results are presented as a stage model of leader assimilation and the development of the LMX. The data strongly indicates that the expectations formed prior to the entry of the new leader can influence the development of LMX relationships, and therefore, the leader assimilation. Data indicates that there is a link between the expectations formed prior the entry and the attitudes of the subordinates towards the new leader in the latter stages of the processes. Those subordinates, who had the most optimistic attitudes, were the most positive towards the new leader and the development of the leader-member relationships later on. Due to that, some connections between the expectations and the development of the LMX were discovered. The expectations prior to entry were compared with the attitudes approximately eight months with the new leader, and the data strongly indicates that there is a link between the optimistic/pessimistic expectations and the attitudes later on. Therefore, optimistic and pessimistic expectations might have an impact on how the LMX relationships and the leader assimilation will develop. The data indicates that the situational factors are likely to have an impact on the attitudes formed by the subordinates. As the new leader enters the organization, the assimilation process is mainly affected by the first meeting and the attitudes and feelings linked to it. The first thing is the existence of the whole new reality for a leader and coping with that reality. The methods the leader employs to make sense of that new reality are mainly information seeking tactics and orientation offered from the side of the organization. It appears that for the new leader the process of observing others is necessary when gaining knowledge of their role and the reality of the organization. Moreover, by observing other employees the new leader attains knowledge about the formal and informal systems of the organization and the roles individuals have. In addition to the information seeking by the leader, there are three interaction processes identified between the leader and their subordinates having an impact on the construct of LMX relationships after 125

122 the organizational entry of a new leader. The first one is the positive delegation-answer-cycle, in which the leader delegates some tasks to a subordinate, and the relationship between the parties is enhanced through the mutual exchange during the delegation. This factor has a positive effect on the relationship between the parties. Besides that, there are also some negative or reverse delegation-answer-cycles evident in the case organization. In the negative/reverse cycles the leader withdraws from the delegation cycle, which has a negative influence on the LMX development process. In this case the withdrawal was not necessarily intentional, but it seemed to have had an effect on the perceptions and feelings of the subordinates about the leader. Moreover, there is also a third interaction process, which seemed to have had an impact on the leader and the LMX relationships developed with the subordinate group. These factors are identified as critical incidents between the parties. These incidents are single occurrences that can be positive or negative and occur between the leader and the subordinate(s). The incidents are perceived as having a great impact, not only to the leader, and the subordinate with whom the critical incident occurs, but also the subordinates who are not directly related to the incident. The main findings at the third stage of the leader assimilation and the development of the LMX are related to learning of the leader and their ability to develop interpersonal relationships in the new organization. From the viewpoint of the new leader the most important elements in becoming an insider and a true member of an organization appears to be the combination of learning the ropes, and therefore, taking charge and developing interpersonal relationships in the organization. Throughout this developmental model a process of leader assimilation and the LMX can be seen as being build as the leader learns the informal and formal organization and develops interpersonal relationships. In addition to the new organizational reality, the leader has to develop LMX relationships with all of their subordinates, and for the new leader the processes are challenging. It seems that the prerequisite of leader assimilation is the development of interpersonal relationships. The data also illustrates that the process of leader assimilation requires the new leader to feel assimilated, but also it requires the subordinates to accept the leader, and therefore, feel that the leader is assimilated 5. Discussion The link between the expectations formed prior to the first meeting have been identified as influencing the organizational assimilation, but the theory of LMX has traditionally recognized the first meeting as being the starting point of the development of the LMX relationships (Dienesch & Liden 1986: 626). The development process at this stage is usually perceived as being influenced by the traits and behaviour of the parties (Bauer & Green 1996: 1542; Dienesch & Liden 1996: 627) and how the parties see each other. This study, however, implies that as the newcomer comes to a managerial position, the strong expectations the subordinates formed prior to entry might have an effect on how the LMX relationships develop later on. Leader-Member Exchange relationships are often recognized as being built through delegation-answercycles (Scandura & Lankau 1996). This study supports the previous research and suggests that there were some kinds of delegations in the case company that did enhance the LMX relationship between the new leader and the subordinate. There is evidence on the LMX relationship between the parties being more complex and being influenced by different incidents. Especially when the subordinate interprets the incident negatively, it negatively influences on the attitudes towards the leader. Since the actions of the new leader during these incidents 126

123 impact on how their subordinates see them and their role, the incidents are presumably affecting the LMX development process. Previous study supports this conclusion; the perceptions of the subordinates of unjust behavior on the side of the leader have an effect on, for example the workplace climate and the interpersonal relationship in the organization (Scandura & Lankau 1996; Andiappan & Trevino 2010). The previous study shows that the process of the leader getting fully assimilated into an organization can take some time (Downey 2002), however, the LMX relationships have been seen as developing quickly to their final form and staying stable over time (Bauer & Green 1996; Dienesch & Liden 1986). This study, conversely, argues that in the situation where the newcomer comes to a managerial position the process of developing LMX relationships is not as rapid as suggested in the previous study, although the new leader might have some previous managerial experience. One major obstacle for an external leader seems to be the fact that they have to learn basically everything: a completely new organization; its culture and ways of working, and in addition, develop LMX relationships with all of their subordinates. It seems that the difficulty of being able to develop multiple LMX relationships at the same time has an impact on the pace the external leader is able to assimilate and make a leader transition. 7. References Andiappan, M. & Trevino, L Beyond righting the wrong: Supervisor-subordinate reconciliation after an injustice. Human Relations, 64, Bauer, T. & Green, S Development of leader-member exchange: A longitudinal test. Academy of Management Journal, 39, 6. Burke, R. & McKeen, C Facilitating the New Manager Transition: Part I. Executive Development, 7, 2, Danserau, F., Graen, G. & Haga, W A Vertical Dyad Linkage Approach to Leaderships Within Formal Organization. Organizational Behavior and Human Performance, 13, Dienesch, R. & Liden, R Leader-member exchange model of leadership: A critique and further development. Academy of Management Review, 11, Downey, D HR's Role in Assimilating New Leaders. Employment Relations Today, 28,4. Eriksson, P & Koistinen, K Monenlainen tapaustuskimus. Julkaisuja 4. Kuluttajatutkimuskeskus Kerava: Savion kirjapaino. Fairhurst, G. & Chandler, T Social Structure in Leader-Member Interaction. Communication Monographs, 56, 3, Hess, J Assimilating newcomers into an Organization: A Cultural Perspective. Journal of Applied Communication Research, 21, 2, Jablin, F Organizational entry, assimilation, and exit. In F. M. Jablin & L. L. Putnam (Eds.), The new handbook of organizational communication, Thousand Oaks, CA: Sage. Liden, R. & Graen, G Generalizability of the vertical dyad linkage model of leadership. Academy of Management Journal, 23, Liden, R. & Maslyn, J Multidimensionality of leader-member exchange: an empirical assessment through scale development. Journal of Management, 24, Manderscheid, S. & Ardichvili, A New leader assimilation: process and outcomes. Leadership & Organization Development Journal, 29:

124 Miller, V. & Jablin, F Information Seeking During Organizational Entry: Influences, Tactics, and a Model of the Process. The Academy of Management Review, 16, 1 Myers, K. & Oetzel, J Exploring the Dimensions of Organizational Assimilation: Creating and Validating a Measure. Communication Quarterly, 51,4. Ostroff, C. & Kozlowski, S Organizational Socialization as a Learning Process: The Role of Information Acquisition. Personnel Psychology, 45, Scandura, T. & Lankau, M Developing Diverse Leaders: A Leader-Member Exchange Approach. Leadership Quarterly, 7(2), Sparrowe, R. & Liden, R Process and structure in leader-member exchange. Academy of Management Review, 22, Van Breuklen, W., Schyns, B. & Le Blanc, P. (2006). Leader-Member Exchange Theory and Research: Accomplishments and future challenges. Leadership, 2, Yin, R Applications of case study research. Thousand Oaks (CA); London: Sage Publications. 128

125 HUMAN FACTORS IN MAINTENANCE FOR A SUSTAINABLE MANAGEMENT OF BUILT ENVIRONMENT Attaianese E. University of Naples Federico II, Department DICATA, Laboratory of Applied and Experimental Ergonomics (LEAS), Via Tarsia 31, 80135, Naples The paper analyzes the role of human factors in building maintenance in order to enhance sustainablity in management of built environment. As maintenance context is a net of interactions among people, as direct and indirect users of built environment, architectonic systems to be maintained, tools and environment, the paper is aimed to show how socio-technical system interactions can be improved considering physical, cognitive and organization aspects of maintenance, for increasing processes sustainability in terms of effectiveness and efficiency assuring, in the same time, safety and well being of all different subjects involved. Considering maintainability as a key performance of built environment sustainability, a set of performance indicators and attributes for a supportive and sustainable maintenance are presented. Building and infrastructures sustainability, maintainability, ergonomics 1 Introduction In the last fifty years maintenance has deeply evolved in terms of scopes, norms, praxis and, above all, nature of systems to which it can be referred. From simple and occasional actions, mainly oriented to maintain efficiency of industrial machineries, maintenance activities have gradually become an organized combination of tasks, finalized to keep or reinstate all kind of entity, in the state allowing to performe a requested function. More recently, also under the influence of Total Quality and Total Productive Management issues (Campbell and Reyes-Picknell, 2006), maintenance increased its role becoming the combination of all technical, administrative and managerial actions during the life cycle of an item intended to retain it in, or restore it to, a state in which it can perform the required function (EN ). In order to front the challenges of sustainable development and global crisis question, maintenance is now considered an optimization strategy especially referred to built environment (Sohail, Cavill, and Cotton, 2005). In fact main scope of maintenance is the continuity in keeping of building and infrastructures estate capacity to perform required functions, so that their utilization by users is complete and uninterrupted or, in other words, it concerns the totally of all actions that keep a building functioning effectively. Thus it assumes a crucial role for building sustainable management considering the chance it gives for a conscious resources utilization, as every action on a building component has the potential to improve or decrease its serviceability. Building maintenance appears as a complex process. In fact, more than in other fields, it is influenced by a multifaceted context, with the high risk to became a unsustainable practice because different needs have to be matched with different expectations, involving different systems and limited resources. Given the complexity of maintenance system, due to its human, technical and organizational variables, building efficiency, and its consequent effects on building sustainable management, depends on how systems and components are prearranged -that is designed- to be maintained (Che-Ani et al. 2009). Therefore maintainability is a key performance area of building sustainability. 129

126 2 Objectives Maintainability is the primary parameter by which it is possible to assure efficiency of maintenance system. It can be defined as the success probability of a specific maintenance action on a given element in a specific timeframe by a determined skill/professional profile, with specific tools and procedures (MIL-HDBK ). Then, maintainability comes from the combination of technical specifications of maintained systems with all other factors in the maintenance context, from human ones to procedural, infrastructural, financial ones. This pragmatic approach is aimed to shape built environment in order to guarantee high efficiency levels of building life-cycle, through the definition of technical specifications able to achieve a supportive operational context (Attaianese 2008, Attaianese, 2009). Therefore maintainability design has to be oriented to qualify and quantify all factors of the maintenance system, by way of an approach like the ergonomic one, allowing to highlight and optimize the interactions involving humans in organized contexts. Applying the human factor perspective it is possible to understand features of technical and social systems able to make operation and maintenance effective, efficient and satisfying. The elicitation of maintainability requirements will be allowed defining characteristics of the system to be maintained best fitting human characteristics. 3 Methods Human-system-environment interaction in building and urban maintenance may be well observed applying the SHEL model of human factor (Hawkins 1987), since this model emphasizes the interaction between a person and the other components of this system representation, rather than the single components themselves. Each person is applied to and interacted with the other four components within human characteristics and possibilities, since it is believed from this theory that a mismatch between the four components always leads to a source of human error and system general ineffectiveness. In the maintenance framework we can intend the SHEL system as follows: - as Hardware, the various physical material entities, such as equipment and tools by which operation and maintenance tasks can be execute, but also buildings or component to keep maintained; - as Software, all non-physical resources, which are for organically operation, like organizational policies/rules, procedures, manuals and information; - as Environment, not only the factors which influence where people are working such as climate, temperature, vibration and noise, but also socio-political and economic factors; - as Liveware, all human elements related in maintenance with their knowledge, capabilities and limitations, attitudes and cultures. Since the scope of maintenance actions is to accomplish tasks for problem fixing or functional upgrading, doing controls, substitutions and adjustment operations, tools and devices and all kind of instrumental entities, can be considered as intermediary elements between human and maintained systems. This mediation has a significant role in maintenance, since effectiveness of maintenance actions on built environment comes, mostly, from effectiveness of tool usage doing those actions. In this view, many interactions among peoples, maintained objects and tools should be adequately investigated in order to understand how to arrange conditions for an operating maintenance. Finally, human-human interaction concerns interpersonal relationships and communication process establishing among the several maintenance figures as well as between final users and maintenance staff, often triggering accidental interactions, with consequent potential conflicts and annoyance situations. The analysis of physical, cognitive, social and organizational aspects, supported by human factor approach, can contribute to improve maintenance oriented activities, because it can help to find how human-systems interactions can be facilitated. Physical aspects, generally well known in the maintenance handbooks, focuses the human physical capability and limitation in order 130

127 to realize how to asset or configure an operative space fitting operators characteristics and tasks needs, assuring, in the same time, effectiveness of operations and their healthiness and safety. Cognitive aspect is concerned with mental processes, focuses human mental capability in order to realize which features of equipment and tools can improve trouble shooting and problem-solving operations, by decreasing the risk of errors, not only acting by fixed procedures, but enhancing monitoring, control and surveillance tasks. The problem of human error is a crucial issue in industrial maintenance (Dhillon and Liu 2006), but few has been applied to built environment (Attaianese 2008). Organizational aspect focuses individual and grouping behaviors in relation to collaboration and participation of different maintenance stakeholders, allocation and delegation of responsibilities, design and application of rules and procedures, in order to improve programming and planning activities. An important role in building maintenance is played by final users. Users consciousness and involvement introduce in maintenance strategies able to overcome the strict task assignment of functional competences, focusing on the fact that only a small number of maintenance activities could requires actually advanced skills, while many of them can be successfully carried out with any particular competence or instrument. In this view maintenance is meant as the whole of actions aimed not only to broken-downs repair, rather than to the prevention, continuous improvement and handover of simplest maintenance actions done by building tenants and occupants. Building systems and components state monitoring by inhabitants, for example, allows to grasp any indication, as far as feeble, about their decay conditions and gives the possibility to adjust their working to assure comfort and well-being in a wide range of use conditions. They act in advance and opportunely, with clear positive effects on resources optimization, waste and financial costs reduction. But, if users involvement becomes more and more relevant, adequacy of operational contexts is a crucial matter, for both aspects technical and organizational, in order to avoid human errors and possible damages, and assure the effectiveness of not-specialized operations. 4 Results The application of human factor perspective conducts to identify a set of indicators for a supportive and sustainable maintenance context of built environment. Since maintainability conditions depends on the whole of context features allowing to perform maintenance activities effectively and efficiently, they concern the way in which actions are carried out, the specificity of places in which those activities are performed, the features of appliances used to maintain systems and the skills and motivations of various people involved in maintenance tasks. Moving from the premised that maintainability conditions may be seen as the whole of necessary situations for assuring adequate quality levels of maintenance activities, we can detail them referring to each element of the context. They are: systems to be maintained; instruments and tools supporting maintenance; operational space where maintenance activities are executed; maintenance tasks to be carried out. Each element of the maintenance context has to be featured by a set of indicators complying maintenance needs. A group of qualitative and quantitative criteria can detail each indicator, in order to identify how design and control built environment to assure maintainability, and thus to increase maintenance efficiency, as reported in Table Detectability It is a condition of the built environment/building/technical element/system component allowing and favoring its identification to gain maintenance goals. It can be specified in terms of capacity to easy localize each element within a system (Localization), to execute actions for troubleshooting and/or for controlling and inspections (Testability and Checkability). 4.2 Accessibility 131

128 It is a condition of the built environment/building/technical element/system component allowing and favoring to operators arrive and access to execute maintenance activities. It can be specified in terms of capacity to point out to human senses (Visibility, Perceivability), and to offer reachable and dimensionally adequate access points (Reachability, Transitability). 4.3 Comprehensibility It is a condition of the built environment/building/technical element/system component allowing and favoring to simply understand their operational using tasks. It can be specified in terms of capacity to quick recognize systems functioning modalities (Self-explainability) also giving, where needed all information about their use (Contextual information). We can refer this condition also to maintenance actions, in order to effectively transmit task guidance to users and operators according to their skills, experience and attitude (Clearness and effectiveness of communication). 4.4 Operability It is a condition of the built environment/building/technical element/system component allowing and favoring the comfortable execution of maintenance activities. It can be specified in terms of capacity to realize adequate postural conditions for operators acting on maintenance systems (Postural adequacy); to present function independence and standard units (Modularity and Standardization) easy to be replaced (Replaceability) and exchanged with a slightly different part (Interchangeability); to permit that maintenance actions can be easily exerted by hands, avoiding any accidental switch-on (Resistance to accidental activation); to be easily cleaned (Cleanable); repaired (Repairability), disassembled and removed (Subassembly end removal); error tolerant; easy to adjust (Adjustability). The condition of easy to operation can be helpfully referred also to maintenance tasks in terms of operators physical and mental effort control and activities practical execution easiness. 4.5 Documentability It is a condition of the built environment/building/technical element/system component allowing and favoring maintenance data collection and updating. It can be specified in System to be maintained Maintenance instruments and tools Maintenance operational space Detectability Localization Testability Checkability Accessibility Visibility / Perceivability Availability of entry points Dimensional adequacy of entry points Reachability Transitability Comprehensibility Self explainability Contextual information Clearness of communication Training effectiveness Operability Postural adequacy Standardization / Modularity Replaceability Interchangeability Maintenance tasks 132

129 Easy to handle Resistence to accidental activation Cleanability Repairability Dismountability / Removability Fault tolerance Adjustability Mobility Physical effort control Easy to use / to execute Mental effort control Salubriousness Comfort Flexibility Controllability Documentability Information availability Information traceability Information updatability Table 1 The matrix highlights in rows the key performance indicators and relative attributes for each element of maintenance context (in columns). terms of capacity to easy identify input and output technical data about maintenance task (Information availability) and easily detect and update actors and steps of maintenance processes (Information traceability and adaptability). 4 Discussion A supportive maintenance context is crucial to guarantee built environment efficiency, in order to assure resources optimization and stakeholders wellbeing and satisfaction, especially inhabitants. Since maintenance efficacy is a function of maintenance processes effectiveness, the consideration of human factors perspective is relevant to identify technical requirements and specifications for planning and executing effective maintenance activities, in a sustainable framework. Given that clear and efficient connections bring to increase autonomous and conscious resources utilization, the focus on people interactions with technical and social systems emphasizes, also in the maintenance, the active role of users in sustainability issue, since an effective usage of built environment systems is strategic to encourage environment friendly behaviors. Since maintenance affects the whole life cycle of built environment, this study could help to highlight the need of human factors approach in the different stages of built environment construction process. At design, construction and management stages, when unsatisfactory detailing, incorrect selection of building materials, components and systems, and lack of standardization have been detected as factors for the occurrence of construction main defects, also caused by incorrect assembly on site or in factory, or when built environment spaces and layout create operative space often inaccessible for maintenance tasks; or when facility management of built environment can show ineffectiveness and inefficiency due to lacks in information availability and exchange from different skills involved. At the stage of end-users fruition, when incomprehensible and/or not-easy to control devices of built environment systems, influence resources depletion; and/or when lacks in communication between tenant and maintenance staff can affect effectiveness of building functions due to inadequate programming of maintenance executive process. 133

130 6 References Attaianese, E Progettare la manutenibilità, Liguori, Napoli. Attaianese E Ergonomics in maintenance for energy sustainable management, in Maintenance Management Conference Proceedings, Italian National Committee for Maintenance, Roma. Attaianese, E. & Duca, G Human factors and ergonomic principles in building design for life and work activities: an applied methodology, Theoretical Issues in Ergonomics Science,, First published on: 30 September 2010 (ifirst) Campbell, J. D. & Reyes-Picknell, J Uptime, 2nd Edition: Strategies for Excellence in Maintenance Management, Productivity Press. Che-Ani, A.I. Chohan, A.H.. Goh, N.A. Tahir, M.M. Surat, M. Usman, I.M.S Sustainable Design Formulation in Achieving Best Practice of Building Maintenance, World Academy of Science, Engineering and Technology, 53. EN 13306:2001. Maintenance Terminology. European Standard. CEN (European Committee for Standardization), Brussels. Hawkins, H. F Human Factors in Flight, Gower Technical Press Ltd. World Academy of Science, Engineering and Technology, 53. MIL-HDBK A Designing and Developing Maintainable Products and Systems DTD Aug 4 Sohail, M. Cavill, S. Cotton, A Sustainable operation and maintenance of urban infrastructure : Myth or reality? Journal of urban planning and sustainable development, vol. 131, no1,

131 THE HUMAN COMPONENT OF SUSTAINABILITY: A STUDY FOR ASSESSING ENERGY EFFICIENT CONSTRUCTION BLOCKS Erminia Attaianese, Gabriella Duca University of Naples Federico II As well known, sustainability is a wide comprehensive topic, where energy consumption is only one aspect of spent resources in the construction process. Many approaches to sustainability issues in construction states the relevance of the human component consideration in the built environment. In the majority of cases human factors are taken into account with reference to health, wellbeing and safety of building occupants. In this view, attention is paid mainly to healthiness of HVAC systems or materials. On the other hand, the sustainability approach to the whole construction process focuses on materials and building life cycle costs or energy consumption during building use. The proposed paper is aimed at highlighting a further aspect of resource consumption in the construction process, that is human efforts needed for set-up any construction technique. The on-going study discussed here starts from the observation that traditional construction materials, and especially bricks, have reached an optimization in weight and dimensions as consequence of human hands dimensions and strength abilities. This sort of informal standardization (and then of suitability of construction materials to human characteristics) is overcome by the use of innovative materials conceived to enhance environmental performances in construction. A very interesting case is represented by high energy efficient blocks for external walls. In fact, it can be observed that high efficient blocks have generally consistencies, shapes, dimensions or weights rather different from traditional wall-brick systems. These differences let suppose that changes in bricklayers workload have come up, and a deeper understanding of workers resources needed for job completion is worthy to be investigated. Here a study is presented based on the comparison of 4 types of external wall blocks offering comparable high acoustic and thermal performances; selected blocks have been assessed in order to understand the type and quantity of human effort needed for their settingup. The investigation of human performance of blocks has been carried out according following steps: - task analysis describing detailed actions, number and type of movements, physical demand - block analysis describing blocks dimensions and weight,the presence of aids for grasping, cutting, laying - tools & complementary materials (e.g mortar) analysis, describing efforts and injury risk coming from needed tools and materials Research is still ongoing, but first findings demonstrate that techniques with similar environment performances offers different performances for the workers resources perspective, and some technique determine working conditions worst than traditional bricks. These findings are useful data for corporate social responsibility approach as well as for workers driven design decision among alternative techniques. 135

132 Interviews with employees reporting work-related injuries as the basis for intervention Antonsson, Ann-Beth IVL, Swedish Environmental Research Institute and KTH, Royal Institute of Technology 1. Introduction There is a growing interest for interventions and intervention research. There is however little research on what factors should be included in interventions. A common intervention strategy seems to be a participatory approach, but interventions focusing on a few defined control actions are also common. At the same time, there is a growing understanding of the complex causes of injuries, often expressed as the need for multifactoral interventions in order to reduce work-related injuries. There seems to be a need for new methods that can form the basis for effective multifactoral interventions. 2. Objectives To develop a method that will identify many contributing causes of work-related injuries and serve as the basis for effective interventions. 3. Methods A method based on interviews with employees reporting work-related injuries was developed and applied on two groups, cleaners reporting MSD and employees in the health care sector reporting sharp injuries. The interviews covered a broad field ranging from for example the injury as such, the work and what causes the interviewees judged to have contributed to the injury, how the injury and the causes of it was handled at the workplace level and if any preventive actions were taken as a result of the injury. The interviews were made via phone and lasted from about 15 to 30 minutes. The interviews were compiled, thematically analysed and interpreted together with experts from the sector. Several new contributing factors were identified. 4. Results The interviews provided a multifactoral perspective on the causes of the injuries. Especially interesting was the improved understanding of the organisational causes and how the workplaces (not) dealt with the injuries. In the case of the cleaners, several factors increasing the work load were identified that can hardly be identified through observation only. Preliminary results from interviews about sharp injuries will be presented at the conference. 5. Discussions and conclusions The method has this far proven to produce interesting and down to earth understanding of contributing causes. Interventions based on the results will probably reduce risks effectively. 136

133 B2: COGNITIVE ERGONOMICS & HUMAN FACTORS B2.1 Effect of gloves on the usability of TETRA phones in cold conditions Kirsi Jussila B2.2 Explaining innovation success and failure. Designers' views on factors affecting innovation processes Minna Pärttö B2.3 Increasing automation and design of a user interface to improve the physical working situation for band saw blades straightening Lars-Ola Bligård B2.5 Usability of mobile phone diaries to record symptoms and physical activity Reetta Heinonen 137

134 EFFECT OF GLOVES ON THE USABILITY OF TETRA PHONES IN COLD CONDITIONS Jussila K and Sormunen E Finnish Institute of Occupational Health, FI Oulu, Finland The TETRA digital radio communication system is widely used in emergency services. The usability of three TETRA phones was tested by four male test subjects using three different types of gloves, as well as while bare-handed, during a simulated communication situation at 20ºC. Significant differences (p<0.05) were found in the use of the tangent and volume control pushbuttons and in changing the communication group. The results showed significant differences in usability when the different gloves were worn. The usability of the phones was evaluated as the best when the firefighter's leather gloves were worn compared with the other tested gloves. Keywords: Usability, Visual Analogue Scale (VAS), System Usability Scale (SUS), Gloves, Cold 1 Introduction Usability can be defined as the extent to which a product can be applied by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use (SFS EN ). In this context, effectiveness can be defined as the degree of success in dealing with a product. Efficiency means the time needed to carry out a task with the product; meanwhile satisfaction refers to a positive attitude towards the use of the product (Jokela 2010). TETRA phones are an essential part of the work in rescue operations. The TETRA digital radio communication system, based on the Terrestial Trunked Radio standard, is widely used in emergency services in Europe and in many other countries throughout the world. Technically, TETRA phones resemble civilian mobile phones, but they must be usable at the site of accidents in all environmental conditions (Valajärvi 2007). Being able to maintain usability and efficiency in harsh weather conditions becomes a crucial factor. Not only phones, manual dexterity must be maintained in spite of cold conditions, and the use of gloves must be possible. Manual performance in the cold is affected by cold temperatures, contact with cold surfaces, and the wearing of gloves. A previous study has shown that working bare-handed in extreme cold conditions for more than a few minutes deteriorates manual performance. The risk of cooling hands is strongly reduced by gloves, but, at the same time, they affect dexterity (Havenith et al. 1995; Rogers and Noddin 1984). 2 Objective The aim of the study was to compare the usability features of three different TETRA phones with different types of gloves during a simulated communication situation in the cold. Another objective was to produce information for the authorities to help improve work ability and efficiency in cold conditions. 3 Materials and methods 3.1 Study population Four male rescuers in the Oulu region of Finland volunteered as test subjects for the study. Their average work experience was 5 years 9 months (standard deviation 6 months). All of them were experienced TETRA phone users. 138

135 Three of the four men were left-handed. The average measure from the top of the middle finger to the end of the palm was 19.3 cm (standard deviation 1.5 cm). 3.2 Material The tests were made with three different TETRA phones, P1, P2 and P3 (Figure 1 A C), using three different types of gloves: firefighter's leather gloves, firefighter's textile/leather gloves, and work gloves (Figure 2 A C), as well as bare-handed, during a simulated communication situation. The average weight of the phones was 279 g (standard deviation 9 g). A) B) C) Weight 288g Weight 270g Weight 278g Figure 1. The tested TETRA phones: P1 (A), P2 (B) and P3 (C). A) B) C) Figure 2. The used firefighter's leather gloves (A), firefighter's textile/leather gloves (B), and work gloves (C). 3.3 Procedure The usability tests were performed in two separate climatic chambers at 20ºC and in a wind speed 0.3 m/s. The test subjects were standing in the chamber during the tests, their physical work load being very light, about 75 W/m² (ISO ). They were wearing firefighter's protective gear with a long sleeved shirt and long legged thin trousers with their own underwear underneath. The thermal insulation of the protective gear was about 3 clo (0.47m²K/W) (Jussila & Anttonen 2011). In order to adjust to the tested TETRA phones, the men were allowed to use the phones before the measurements began. Each situation was set in random order. Before the tests, the phones were placed in the chamber for 20 minutes to cool them. The simulated communication situation was controlled, and tasks were given by phone. The controller of the simulation was placed outside of the chambers to avoid audibility from the same room. The time used for each task was not recorded systematically as the length of the conversation during the simulation varied. The simulation lasted between 5 and 8 minutes. The situation included the following tasks: responding to a call, conversing through the phones, changing the communication group two different ways, when told to by phone, and adjusting the volume. The testers indicated once the each task was performed. 139

136 3.3. Measurements After the simulated communication tasks, a visual analogue scale (VAS) was used to evaluate the usability features of the three different phone types: such features as the fit for the hand, the shape and weight of the phone, the placement of the tangent push-button, the shape of the push-buttons, the clarity and size of the screen, screen update in the cold, changing the communication group, the audibility of the speaking voice, and the volume control. In addition, an overall evaluation was made of the phones and their handling. The testers rated the perceived features on a VAS with a range of 0 to 100 millimetres (0 = very poor to 100 = very good) (Price et al. 1983). A repeatedmeasures analysis of variance (ANOVA), followed by Bonferron post hoc tests, was used to test the equality of the mean values of the VAS scores between each situation in which the TETRA phones were used. The differences between the phones were tested using a paired sampled t-test. The data are presented as means and standard errors, and the differences were considered statistically significant if p<0.05. The results were analysed using Microsoft Office Excel The global view of systems usability with respect to the TETRA phones was evaluated with the use of the System Usability Scale (SUS). The statements covered the following aspects of system usability: training, complexity, and need for support. System usability was presented as the theoretical percentage of "perfection" with a range of 0 to 100. The SUS questionnaire is regarded as a valid tool for usability assessment (Brooke 1986). Furthermore, the testers were asked which TETRA phone they would choose as the best, second best, and third best in case of a disaster (Lintula and Nevala 2006). All of the free comments about the usability of the phones were taken into consideration. 4 Results The results of the perceived usability of the three tested TETRA phones, when used with three different types of gloves, as well as bare-handed, as based on the VAS, are presented in Table 1. They show significant differences in phone usability (p<0.05) only for such tasks as using the tangent and volume control push-buttons and changing the communication group. Table 1. Mean values with standard errors of perceived usability (visual analogue scale, from 0 = "very poor" to 100 = "very good") for the features of the different TETRA phones as rated by the rescuers (n=4) after the simulated tasks. Usability feature P1 P2 P3 ANOVA Fit for hand Bare-handed Leather glove Work glove 79 ± ± ± ± ± 9 58 ± ± ± ± 31 ns ns ns Textile/leather glove 61 ± ± ± 26 ns All 78 ± ± ± 18 ns Use of the tangent push-button Use of push-buttons Changing communication group Bare-handed Leather glove Work glove Textile/leather glove All Bare-handed Leather glove Work glove Textile/leather glove All Bare-handed Leather glove Work glove Textile/leather glove 88 ± 7 79 ± 8 77 ± ± ± 6 76 ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± 8 75 ± ± ± ± ± ± ± 28 8 ± 5 56 ± ± ± 7 51 ± 28 6 ± 4 ns ns ns ns p<0.05 ns ns ns ns ns ns ns ns ns 140

137 Volume control Overall handling Suitability with gloves Bare-handed Leather glove Work glove Textile/leather glove All Bare-handed Leather glove Work glove Textile/leather glove All Leather glove Work glove Textile/leather glove All 49 ± ± ± 6 p<0.05 ns p<0.05 ns p<0.05 p< ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± 9 51 ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± 29 7 ± 6 Overall evaluation All 70 ± ± ± 17 ns ns = not significant Significant differences were found for such usability features (p<0.05) as using the tangent and push-buttons, changing the communication group, the overall handling, and the suitability with gloves when the different gloves were worn during communication with the TETRA phones (Table 2). For each feature, the usability of the phones was evaluated as the best when the firefighter's leather gloves were used compared when the other gloves were worn. The SUS score for phone P1 was 51, for P2 it was 81, and for P3 it was 77. As regards communication in extreme cold conditions, 75% of the testers chose the P2 as the best communication device in case of disaster. The P3 phone was considered the best by 25% of the testers. P1 was considered as the least suitable for communication in disasters in the cold by 50% of the testers, the corresponding value for P2 being 25%, and that for P3 being 25%. The free comments mentioned that cold stiffened the push-buttons and tangent buttons. Table 2. Mean values with standard errors of perceived usability (visual analogue scale, from 0 = "very poor" to 100 = "very good") for the features of the TETRA phones with different gloves as rated by the rescuers (n=4) after the simulated tasks. Usability feature Barehanded Leather Work Textile/leather ANOVA glove glove glove Fit for hand 79 ± ± ± ± 27 ns Use of the tangent push-button 79 ± ± ± ± 19 p<0.01 Use of the push-buttons 76 ± ± ± ± 16 p<0.001 Changing communication group 77 ± ± ± ± 24 p<0.001 Volume control 72 ± ± ± ± 23 ns Overall handling 72 ± ± ± ± 18 p<0.01 Suitability with gloves 64 ± ± ± 22 p<0.001 ns = not significant 5 Discussion and conclusions The results of the perceived usability of the tested phones showed significant differences in usability features (p<0.05) such as use of the tangent and volume control push-buttons and the ability to change the communication group. The phones differed in size, shape, placement, and depth of the push-buttons, and these variations assumably led to the differences. The volume control of P1 (made by a roller) was evaluated as being easier to use than that of P2 and P3 (controlled by push-button). It is known that the use of gloves affects manual performance. According to previous research, the lowest temperature for practical performance bare-handed for more than a few minutes is -18 C ns ns ns ns ns ns ns ns 141

138 (Rogers and Noddin 1984). Therefore, a person should be able to use a device in extreme cold conditions with protective gloves on. In our study, the most significant differences were found in the usability features when the different gloves were worn during the use of phones. The firefighter's leather gloves were perceived as the most suitable for use with TETRA phones. The leather gloves provided better dexterity than the other gloves. Properties such as the stiffness and thickness of the fabric used in the gloves and the pattern of the glove affected manual dexterity and finger mobility by hindering the movement of the fingers. If the duration of the tests would have been longer or if the testers would have been cooled before the test, the effect of cold on their manual performance would have been more significant. The best possible match between the product and its users can be achieved by evaluating the product within an authentic or simulated operating situation among real users (Pheasant 1996). In our study, phones were tested in simulated operations. The used SUS method and the testers' responses about the most usable phone in disasters in cold conditions gave the same result. This similarity shows that the selected methods were valid for our study. This study provided information about communication devices and protective gloves that will help emergency authorities develop operative methods concerning communication, and also help improve their effectiveness, efficiency and work ability in rescue operations in cold conditions. The study provides information for device development about the most important factors of the TETRA phones when they are used in the cold. Detailed information about the use of the communication devices in long-term cold exposure is still needed. 6 Acknowledgements This research was carried out as part of the project "Cooperation for Safety in Sparsely Populated Areas, CoSafe" (www.cosafe.eu), which was financially supported by the European Union, the Northern Periphery Programme, and the Ministry of Employment and the Economy of Finland, for which the authors wish to express their thanks. 7 References Brooke, J SUS a "quick and dirty" usability scale. United Kingdom: Digital Equipment Co, Ltd. Havenith, G., Heus, R. & Daanen, H.A.M The hand in the cold, performance and risk. Arctic Medical Research, 54, 2, ISO Ergonomics of the thermal environment - Determination of metabolic rate. Geneva: International Organization for Standardization. Jokela, T Navigoi oikein käytettävyyden vesillä. Opas käytettävyysohjattuun vuorovaikutussuunnitteluun. [Navigate correctly in the field of usability. A guidebook for the usabilitycontrolled design of interaction]. Rovaniemi, Finland: Väylä-Yhtiöt Oy Jussila, K. & Anttonen, H First responders' protective work wear in the cold. Proceedings (CD). International Conference on Fibrous Products in Medical and Health Care, FiberMed11, June 2011, Tampere, Finland. Lintula, M. & Nevala, N Ergonomics and the usability of mechanical single-channel liquid dosage pipettes. International Journal of Industrial Ergonomics, 36,

139 Pheasant, S.T Bodyspace: anthropometry, ergonomics and the design of work. 2 nd ed. London, United Kingdom: Taylor & Francis. Price, D., McGrath, P.A., Rafii, A. & Buckinham, B The validation of visual analogue scale as ratio scale measure for chronic and experimental pain. Pain, 17, Rogers, H.W. & Noddin, E.M Manual performance in the cold with gloves and bare hands. Perceptual and Motor Skills, 59, SFS EN Ergonomic requirements for office work with visual display terminals (VDTs). Part 11: Guidance on usability. Helsinki, Finland: Finnish Standards Association SFS. Valajärvi, E Viestiliikenne viranomaisverkossa VIRVE. [Information transfer through Terrestial Trunked Radio TETRA] In Castrén, M., Ekman, S., Martikainen, M., Sahi, T. & Söder, J. Suuronnettomuusopas. [A guidebook for rescue operations in a disaster]. Helsinki, Finland: Duodecim. 143

140 EXPLAINING INNOVATION SUCCESS AND FAILURE. DESIGNERS VIEWS ON FACTORS AFFECTING INNOVATION PROCESSES Pärttö, Minna Department of Computer Science and Information Systems University of Jyväskylä 1. Introduction The aim of this study was to explore factors explaining failure and success in innovation processes. This study is based on designers own introspective thoughts and subjective vision about designing. It offers insights into designers own conceptions. In this way, we can enhance our understanding of innovation processes and to introduce critical factors in innovation processes in design. Interaction with the client, goal oriented actions, timing, resources and profitable practice were experienced critical when thinking about reasons for innovation success or failure. 2. Method The data consists of eighteen half-structured interviews. Interviewees represented big and medium size design and consulting firms extracted from the register database of the Finnish association of consulting firms, SKOL. Interviewees were mostly from managerial level. We asked designers to tell us factors that explain success and failure in innovation processes. The interviews were digitally recorded and transcribed. The material was analyzed qualitatively using data based content analysis in order to categorize responses. Also quantitative results were achieved when summarizing cases in each categorizes together. 3. Results Altogether 67 comments were given when explaining success and failure of an innovation process. Explaining success gave slightly more comments (n=37) than explaining failure (n=30). Comments related to success were categorized in ten factors: interaction with the client (16,2 % of all success comments), goal oriented and systematic action (16,2 %), continuous development work (13,5 %), utilizing existing knowledge (13,5 %), teamwork (10,8 %), timing (8,1 %), sufficient resources (8,1 %), profitable practice (5,4 %), skillful personnel (5,4 %) and approving failure (2,7 %). Comments related to failure were categorized in twelve factors: inadequate knowledge (13,3 % of all failure comments), false knowledge (10 %), poor timing (10 %), insufficient resources (10 %), stiff organization structure (10 %), complexity of projects (6,6 %), noone in charge (6,6%), insufficient interaction with the client (6,6 %), no goal oriented and systematic action (6,6 %), non-profitable practice (6,6 %), inadequate networking (6,6 %) and conflicts between parties (6,6 %). Factors were furthermore categorized in three groups: 1) Innovation management, 2) Interaction, 3) Knowledge. Innovation management consists of following subtypes: goal oriented and systematic action, timing, resources, continuous development work, profitable practice, stiff organization structure, complexity of projects and no-one in charge. Interaction-category is composed of interaction with clients, teamwork and inadequate networking. Last category, knowledge, consists of subtypes as utilizing existing knowledge, inadequate knowledge and false knowledge. 144

141 4. Conclusions The study illustrated that factors related to innovation management, interaction and knowledge are crucial in innovation activities in design firms. 145

142 INCREASING LEVEL OF AUTOMATION AND DESIGN OF A USER INTERFACE TO IMPROVE THE PHYSICAL WORKING SITUATION FOR BANDSAW BLADES STRAIGHTENING Bligård, L-O 1 1. Division Design & Human Factors, Department of Product and Production Development, Chalmers University of Technology, SE Gothenburg, Sweden The manual work of straightening band saw blade includes tasks of poor physical ergonomics, since the needs to bend and twist the back and neck to be able to see the horizontal line of the blade. This paper presents a case study of how a physical manual work task successfully can be transferred to be machine operated, by developing a graphical user interface, and thereby improving the physical working conditions of the operators. Key words: automation, physical ergonomics, cognitive ergonomics, user interface 1. Introduction Today, the level of automation is increasing in the industry and more work tasks are machine operated. Often, increased speed and quality is the main reason for automation, but another important aspect is to improve the physical ergonomics of the working situation. Figure 1. Worker inspecting a band saw blade In sawmills, large band saw blades are used to split up the logs. The band saw blades can be up to 10 meters long in circumference. When a band saw blade has been in use for a number of hours, it becomes blunt and deformed. The deformation consists of a change in the form of the blade as well as dents and bosses of the blade surface. To be reused the blade must be sharpened and straightened out. The sharpening is made by a machine, but most of the straightening is often done manually by a worker. During the manual straightening, the worker inspects the blade both visually and haptically to identify deformations. Then the worker often needs to bend and twist the back and neck to be able to see the horizontal line of the blade, when a ruler is used to study the curvature of 146

143 the blade. For the straightening, a small rolling-mill and a number of different hammers are used. As shown in figure 1, this working condition creates poor physical ergonomics for the workers performing the saw blade straightening since the workers often bend back and neck and pull the blade with their arms during the inspection and the manual adjustments. A disadvantage of this approach is that it takes a long time to become a skilled worker and it is difficult to measure the quality of saw blades. A worker often needs a year s experience to achieve good results and work quickly since the work is based on experience and manual skill of how to straighten the band. It is not possible to quantify the conditions of the band when it is received from the saw-mill. Some workers treat their blade better than others resulting in more or less effort needed to straightening the blade, but the saw mill is still charged the same cost. To counteract this problem, a saw blade service company built a prototype rig. The rig consists of the ordinary straightening table supplemented with measuring equipment, a PC-computer and a screen with a graphical user interface. 2. Objectives and method This paper presents a case study on the development of this prototype rig. The objectives are to show of how a physical manual work task successfully can be transferred to be machine operated, by developing a graphical user interface, and thereby improve the physical working conditions of the workers. The procedure of the case consists of two parts: development and evaluation. The development consisted of function and task analysis, user participation and user interface design. The evaluation consisted of observation and interviews. 2. Development To decrease unhealthy body positions postures?(and increase speed and quality) when the worker is inspecting the blade, a prototype rig with sensors and a graphical user interface was developed. The interface in the PC-screen presents measurements of the status of the blade, which meant that the measurement did not have to be performed manually. Due to the saw blade service company s policy the PC-screen layout and detailed content can not be presented in the paper. Initially, workers were observed to get an understanding of how the task was performed today. The instruction manual for band saw blade straightening was studied to analyse which information that was needed for the work. After that three experienced workers were interviewed to elicit how they worked today and which information they needed in the work, together with how they thought a future graphical user interface should look like. This resulted in a specification of the task and the needs for performing band saw blade straightening effectively. The next step was to design the graphical user interface which was done in a standard computer drawing program. The suggested interface was shown to the expedited workers and other company representatives to receive feedback for change and improvements of the design. Two iterations of the design were made. In parallel, the new hardware and software for the measurement rig were developed. The last step in the development was the implementation. The design of the user interface was integrated with the software and hardware in the prototype rig and then tested for correct function. Minor changes of the design of the user interface were made for two reasons. First, since the 147

144 software limited the possible design solutions due to standard graphical components. Second, this was the first time the complete system with all parts were integrated and worked together, which also indices design changes. It was only now that real data could be displayed in the interface, which resulted in the modifications. The whole prototype rig then went into test runs with two workers as test pilots. 3. Evaluation When the two workers had been working with the prototype rig occasionally for a few months the evaluation was made. The evaluation consisted of observations and interviews with the workers. During the observation of the work, the number of bending and twisting of the back and the number of pulls to adjust the blade were recorded (Table 1). Table 1. Result from observation. Rx is observation of regular procedure and Px is observation of prototype rig. Blade R1 R2 P1 P2 P3 P4 P 5 P6 P7 Time (min) 2,3 4,3 22,3 59,5 9,5 13,3 15,5 9,46 3,6 Number back bends (#) Frequency back bends (#/min) 4,3 5,1 1,7 1,8 1,1 1,0 0,6 1,0 1,9 Number arm pulls (#) Frequency arm pulls (#/min) 1,0 13,4 0,0 0,0 0,1 0,2 0,0 0,1 0,0 A first reflection is that it is not possible from the observation to make an assessment of if it was the prototype rig or the regular procedure that was the fastest to perform the straightening with. Firstly, too few blades were observed and the blades needed various need of straightening. Secondly, no measurement of blade quality was made before or after the straightening procedure. The first result that is evident by the observation is that the frequency of pulling the blade with arm has decreased dramatically when using the prototype rig. Furthermore, it appears that the frequency of back-bending also decreased from using the rig, but not as much as for the arm pulling. Half of the back bends come from bending when setting the rolling mill to pull the blade during inspection. This was a new task that has appeared due to the increased level of automation. The number of bends due to inspection has therefore decreased more than the table shows. Figure 2 show inspection position with the prototype rig. 148

145 Figure 2. Worker inspecting a band saw blade with prototype rig. Blade P2 stands out among the others blades because it was a difficult band to straighten. The operator had to remove the blade from the rig several times in order to make measurements by hand. Furthermore, the band needed lurch for the straightening to be satisfactory. In the interviews both workers stated that they were satisfied with the design of the prototype rig and that they were able to straighten band saw blades with it. They stated that it was a large difference to straighten the blade with the new rig compared to the old way. With the rig work can be performed in a better way since you always can see what is happening offering improved control and visibility. In the regular procedure you only check the band by sampling measuring positions, but the rig measured along the whole blade, making it better overall. The workers also assessed that the measurements with the rig allows the quality of the straightening to become more consistent since a template for how a fine blade looks like can be used. With the old way, each worker had an individual view of what a fine and straight blade looked like. The workers also indicated that there have been fewer operations with the rig, since they do not have to bend the back for inspection as much as before, and that they do not have to pull out the saw blade manually (this is performed by the mill). Regarding perceived physical strain, the operators thought that it would decrease with the rig, but they said they have not worked enough with the rig to have experienced any differences other than instantaneous. The workers indicated that it might be difficult to learn the interface and to interpret the interface properly, but they thought that it was still much easier than learning to perform the straightening in the regular procedure. They also believed that some workers might find it difficult to shift to using the rig if they were stuck in the regular procedure of working and were unfamiliar with computers. You need to learn to trust the computer's measurements and not only rely on manual measurements for the straightening the band saw blade. The new way of working has also introduced new tasks that did not exist before the rig was introduced. Although the blade must be fitted and locked in the rig, the operators stated that the total number of operations has decreased. The workers also assessed that it took a little longer to straighten a blade in the rig compared to the old way. This is mainly because of the time to place and remove the blade from the rig. It is also possible to do more accurate measurements, which takes more time. The workers thought that the extra time was compensated by the fact that a higher quality is achieved. One worker thought that there would be no problem getting up to speed in the straightening when using the rig after an appropriate amount of training. Both workers highlighted independent two things that they considered to be the main advantages of the prototype rig: the quality of the straightened blades and the physical ergonomics. The prototype rig provides new opportunities to get an overall picture of the band, assess its status, and find defects. In the old way you could miss major defects and not fix them, since you just measured in samples rather than continuously. Furthermore, now the operators do not have to keep the information of the blade's status in mind when carrying out the work, since this is displayed by the interface. Measurements using the rig are more accurate, making it easier to find details and to straighten the blade more carefully. Regarding the physical ergonomics the rig offers less asymmetric working postures. First, the operators stated that they currently did not have to bend their back as many times to measure the 149

146 band, and secondly, they did not need to pull the band by hand since the rolling mill now does it. This supports the results from the observation. 4. Discussion The evaluation shows strong indications that prototype rig has reached its goal to archive better physical ergonomics in and better quality of, the band saw blade straightening. However, more testing of the rig and training of workers is needed to determine how much better it has become and to specify in which ways it got better. So the design process used in the case can be considered to have worked sufficient. The case also shows the clear connection between physical ergonomics and cognitive ergonomics in the human-machine system. The basic idea in the case was to improve the physical ergonomics by transferring harmful work tasks from the human to the machine. But to achieve this, the design of the user interface of the machine is central, since the workers need to understand the interface for them to be able to perform their work. If the design is insufficient when performing the measuring, it will not change the physical ergonomics since, the workers then need to work in their old way with harmful body postures. So the good physical ergonomics is based on a good cognitive ergonomics. In this case knowledge in the cognitive field of user interface were need to improve the physical ergonomics and rather than knowledge of physical ergonomics. There is also the aspect of trust that affects the achievement of better physical ergonomics. If the workers do not trust the measurement, even if it is correct, they will still use the regular procedure to ensure a sufficient result. The case also plainly illustrates the change of work task when increasing the level of automation. Instead of working directly with the hand and the eye, they now looks at a computer screen and interpret the graphics. The skill needed also change from manual skill of intermeeting the condition of a blade, to skill of handling a computer. This means that the existing workers also need additional training to be able to maintain a high efficiency with the rig. Another interesting change in the work is the measurements. The prototype rig made the measurements both faster and more precise, but it took longer time to complete the measurement compared to the manual sampling since the workers now measured more. But on the positive side it made the workers more accurate sine it now was possible for them to objectively inspect their work. Thus, as the workers get a better mental image of the problem with each blade, their working procedure change more that direct motivated by the increased automation. 5. Conclusions The increased level of automation and the design of the user interface seem to have reduced the number of bad working postures. The case shows that there here was a clear connection between the cognitive ergonomics and physical ergonomics, and the cognitive ergonomics significant can contribute to improve the physical ergonomics. The procedure presented in the paper can serve as an example of how to perform automation of a work tasks with user involvement to improve the working situation. 150

147 USABILITY OF MOBILE PHONE DIARIES TO RECORD SYMPTOMS AND PHYSICAL ACTIVITY Heinonen, Reetta (1), Moilanen Jaana(1), Luoto Riitta (2,3), Nygård Clas-Håkan (1) 1. School of Health Sciences, FI University of Tampere, Finland 2. UKK Institute for Health Promotion Research, Tampere, Finland 3. National Institute for Health and Welfare, Helsinki, Finland The aim of the present study was to evaluate the use of a mobile phone application for recording symptoms and physical activity during an experimental physical exercise intervention study. All 158 participants reported daily symptoms by responding to morning and evening questionnaires via mobile phones. The usability of the mobile phone as a data collector tool was evaluated with the System Usability Scale (SUS) questionnaire two months after the intervention. The feasibility evaluation was based on the frequency of responses and open questions. It was concluded that the mobile phone diary is a feasible and usable tool for data collection in filed interventions. Keywords: Mobile phone diary, usability, feasibility, Introduction Data collection in field studies could include among others recording of symptoms, perceptions strains, or and subjects daily activities. Paper-based data collection has been a traditional method of data collection for decades. The new technology offers many other options in data collection including mobile phones or computer-based devices that utilize wireless and mobile phone technology. Hand-held computers have been developed since the early 1990 s and free or commercial software for developing diaries is available. The use of electronic diaries as data collectors or for data monitoring has increased rapidly in interventions and research since they are faster and popular among users (1, 2). Traditionally entries have been made in paper diaries once a day, usually at the end of the day, and such data may be then based on selective memory. With electronic and mobile phone diaries, data such as symptoms could be measured beyond the place or time and recorded as they occur. It is known that patients (users) do not follow the instructions and may fill in the missing entries afterwards, which may possibly affect the results of an intervention or a treatment. The electronic diary marks all entries in the program which ensures that the patient adheres to the protocol. Electronic diaries have been shown to generate valid data for studying symptoms and also more generally in health care (1, 3). Most of the studies concluded that electronic diaries have potential for data collection if validation and usability are taken into account (2-4, 5, 6). The aim of the present study was to evaluate the usability and feasibility of a mobile phone program in recording of symptoms and activities during a physical exercise trial. Objectives 151

148 One hundred and fifty-eight women who had one or more responses in the mobile phone diary were included in the analysis. The women were on average 54.3 years of age and about 70 % were working fulltime. The participants worked 7 to 60 hours a week (mean working hours 35.0±16.2). The subjects were mostly working in mentally demanding jobs (for example as office workers), but also in physical jobs (such as cleaners) and mixed (physical and mental demanding) jobs (such as nurses). A third of the women had a university degree. Methods The study was a randomized exercise trial intended to study the effects of increased physical activity on menopausal symptoms and quality of life. The study was approved by the ethical committee of the Pirkanmaa Hospital District. The duration of the intervention was 24 weeks. A more detailed description of the intervention has been documented elsewhere (10). The exercise programme included aerobic training 4 times a week, 50 minutes per session, with a progressive increase in intensity. Adherence to the trial was supported by an option to participate in supervised aerobics or step aerobics sessions at the research institute twice a week. Every second week they met an exercise instructor. Mobile phone diary A mobile phone diary was used to collect data on symptoms and amount of physical exercise. The application program was commercial, Symbian-based and was downloaded primarily onto the subjects own mobile phones. If subject s mobile phone did not have the necessary features a phone was offered to them by the research project. In both groups 28 of the participants 79 used their own phone. All subjects participated in the introduction and training session where the program was installed on their mobile phones. The subjects had a two weeks running-in period for the exercise programme when they could also practice in using the mobile diary program. All costs of the use of the mobile phone diary were covered by the research project. All data was transferred via Internet (3 G or WAP) to a server of the service provider. The users interface was protected by user name and password. After the application was installed on the users mobile phone, she could use the application without logging in. Questionnaires Information on daytime and night-time symptoms was collected by mobile phone questionnaires twice a day. The mobile phone questionnaire included pre-specified questions on hot flushes, sleep and other symptoms. Symptom questions were modified from the Symptom Check List (SCL-90). Participants were asked to fill in the morning questionnaires on waking up in the morning and the evening questionnaires on retiring to bed. Questionnaires could not be filled in afterwards. The intervention group also reported their exercise after the training session via mobile phone questionnaire. All participants could also send messages to the researcher from their mobile phone programs. Among the questionnaires there were three different types of response options: select yes/no, multiple-choice and text response (captionchoice). Usability measures 152

149 The usability of the mobile phone as a data collection tool was evaluated with the System Usability Scale (SUS) after the intervention. The SUS scale can be used to assess the usability of a variety of products or services. The questionnaire investigated users experiences of questionnaires by mobile phone and the technical support required with the system. Responses were given on a scale from one (totally disagree) to five (totally agree). In the SUS questionnaire there are five positive statements and five negative statements, which alternate (7). Experiences of the use of the mobile phone diary were elicited with two open-ended questions. The questions were: Which factors did you find positive when using the mobile phone diary and which factors did you find negative when using the mobile phone diary? Results In the intervention group (N=79) the average frequency of responses to morning questionnaires was 126 (±40) of all 168 (±14) responses and to evening questionnaires 118 (±45) of all 170 (±41) responses. In the control group (N=79) the frequency of responses was 123 (±4) of all 171 (±13) and 118 (±40) of all 172 (±13) responses respectively. The response activity did not differ between the intervention and the control groups (Table 1). There were no differences in the response rates between those who used their own phones or phones supplied by the research. Table1. Response rates to the mobile phone questionnaires in the study: intervention and control groups. Intervention group (n=79) Control group (n=79) p- differences All (n=158) Morning questionnaires 74.4± ± ±22.0 (%±sd) Usability Evening questionnaires (%±sd) 69.4± ± ±22.7 and users experiences In all 107 women completed the usability questionnaire after the intervention. The average SUS score was 75.4 (range 0-100) showing good usability (8). Of all respondents who answered the open-ended questions (N=111) 101 gave positive feedback. The mobile phone diary was considered a fast and easy way for participants to respond to questionnaires. Users commented that doing the diary "has become a routine." It was also noted that "since mobile phones are part of everyday life, it is easy to remember to fill in the questionnaires". Eighty subjects responded on the question: which factors did you find negative when using the mobile phone diary? The moust common answer was "nothing". Negative comments included technical problems such as network connection problems. Participants also made negative comments on the relevance of the questionnaires, Questionnaires were monotonous" and "there were no option to explain and add responses". Some of the participants who did not use their own phone felt that it was not easy to remember to respond. Discussion Our results permit the conclusion that the response rate and usability of the mobile phone diary was good throughout the intervention. This concurs with other studies on electronic diaries (2,3,5,9,10). Burton et al. (1) in their review reported compliance rates from 76 to 100% of all possible entries. Compared to other studies the duration of our study was quite long and demanding for the participants. However, none of the drop-outs discontinued due to the mobile phone diary, but for other reasons such as personal 153

150 circumstances or chronic illness. In research it is important that subjects participate actively in the study and there should be no missing data, this improves the quality and the reliability of the data (5, 9, 11). The usability of the mobile phone diary was rated good (8), although none of the participants had used a similar application before. Earlier studies have shown that subjects prefer electronic diaries to traditional paper and pen methods. Participants who have used electronic versions of a diary have been more likely to keep it in a more usable and faster way than the traditional method (e.g. paper-pen) (2, 9). The perceived problems during the intervention were mostly due to network problems with the specific mobile operator, which could not be anticipated. The problems were not continuous, but the subject had to try to log on several times, which was stressful to the user. It is important to ensure that the method does not strain the subject too much (12). The software used enabled an easy follow-up of the response activity and there was also an opportunity to give the participants feedback. On-line registration of the responses improved the quality of the collected material and problems could be spotted quickly, as shown in other studies (3, 12). Conclusions The mobile phone diary is a feasible and usable tool for self-reported data collection in filed studies. In further studies more research on the usability of mobile solutions as a research tool in different subject areas is needed. References (1) Burton C, Weller D, Sharpe M. Are electronic diaries useful for symptoms research? A systematic review. J Psychosom Res ;62(5): (2) Lane SJ, Heddle NM, Arnold E, Walker I. A review of randomized controlled trials comparing the effectiveness of hand held computers with paper methods for data collection. BMC Med Inform Decis Mak 2006 May 31;6:23. (3) Krishna S, Boren SA & Balas EA. Healthcare via Cell Phones: A Systematic Review. Telemedicine and e- Health (3): (4) Koop A, Mosges R. The use of handheld computers in clinical trials. Control Clin Trials 2002 Oct;23(5): (5) Bolger N, Davis A, Rafaeli E. Diary methods: capturing life as it is lived. Annu Rev Psychol 2003;54: (6) Kreindler D, Levitt A, Woolridge N, Lumsden CJ. Portable mood mapping: the validity and reliability of analog scale displays for mood assessment via hand-held computer. Psychiatry Res 2003 Sep 30;120(2): (7) Brooke J. SUS - A quick and dirty usability scale. Usability evaluation in industry 1996: (8) Bangor A, Kortum B & Miller J Determining What Individual SUS Scores Mean: Adding an Adjective Rating Scale. Journal of Usability Studies Vol. 4, Issue 3, pp (9) Lauritsen K, Degl'Innocenti A, Hendel L, Præst J, Lytje MF, Clemmensen-Rotne K, et al. Symptom recording in a randomised clinical trial: paper diaries vs. electronic or telephone data capture, Control Clin Trials ;25(6): (10) Luoto R, Moilanen J, Heinonen R, Mikkola T, Raitanen J, Tomas E, Ojala K Mansikkamäki K, Nygård C-H. Effect of aerobic training on hot flushes and quality of life. Annals of Medicine, 2011; Early Online,

151 (11) Tomlinson M, Solomon W, Singh Y, Doherty T, Chopra M, Ijumba P, et al. The use of mobile phones as a data collection tool: a report from a household survey in South Africa. BMC Med Inform Decis Mak 2009 Dec 23;9:51. (12) Palmblad M, Tiplady B. Electronic diaries and questionnaires: designing user interfaces that are easy for all patients to use. Qual Life Res 2004 Sep;13(7):

152 C2: VISUAL ERGONOMICS C2.1 Pain induced by visually demanding computer work: association with muscle activity and muscle blood flow in m.orbicularis oculi Hanne-Mari Thorud C2.2 Sustained periods of ocular load may affect trapezious muscle activity Camilla Lodin C2.3 Temporal aspects of increases in eye-neck activation levels triggered by visually deficient near work Hans Richter C2.4 Neck scapular area complaints in age related macular degeneration patients. Complaints due to old age or decreased vision? A case -control study with age matched controls Christina Zetterlund C2.5 Direct measurements of ciliary and trapezius muscle activity Mikael Forsman 156

153 PAIN INDUCED BY VISUALLY DEMANDING COMPUTER WORK: ASSOCIATION WITH MUSCLE ACTIVITY AND MUSCLE BLOOD FLOW IN M.ORBICULARIS OCULI 1 Hanne-Mari Schiøtz Thorud1, Magne Helland1, Arne Aarås 1, Tor Martin Kvikstad1, Lars Göran Lindberg2, and Gunnar Horgen1 Department of Optometry and Visual Science, Buskerud University College, Kongsberg, Norway 2 Department of Biomedical Engineering, Linköping University, Linköping, Sweden Key words: Photoplethysmography, muscle blood flow, EMG, orbicularis oculi, computer work, pain Eye strain during visually demanding computer work including increased squinting may be related to elevated tension in the orbicularis oculi muscle and development of muscle pain. The aim of this study was to investigate the development of discomfort symptoms in relation to muscle activity and muscle blood flow in m.orbicularis oculi during computer work with visual strain. A group of healthy young adults with normal vision (14 females and 6 males, from 19 to 35 years) was randomly selected at Buskerud University College, Norway. Eyerelated symptoms were measured on visual analogue scales (VAS) during a two hours working session on a laptop with visual stress like glare and small font. Muscle tension was measured by electromyography (EMG) and presented as % of Maximal Voluntary Contraction (MVC), and muscle blood flow was measured with photoplethysmography. During the two hours of visually demanding computer work there was a significant increase in several symptoms like pain and tiredness in and around the eyes, dry eyes and blurred vision. The EMG measurements showed significantly increased and stable orbicularis oculi muscle tension at % MVC during the working session. Orbicularis oculi muscle blood flow increased gradually during the first 30 min of the work session and then there was a decreasing trend in blood flow. Subjects who developed eye-related pain showed elevated orbicularis oculi blood flow during computer work compared to subjects with minimal pain symptoms. These results indicate that muscle pain development during prolonged low-force exercise is not related to impaired muscle blood flow. 157

154 SUSTAINED PERIODS OF BINOCULAR LOAD MAY AFFECT TRAPEZIUS MUSCLE ACTIVITY. Lodin Camilla 1, Mikael Forsman 2, Richter Hans 1 1. Centre for Musculoskeletal Research, University of Gävle, Sweden 2. Division of Occupational and Environmental Medicine, Department of Public Health Sciences, Karolinska Institutet, Sweden The relationship between activity in ocular muscles and activity in neck and scapular muscles that stabilizes gaze is well known. However, it is uncertain if ocular load per se contributes to increased muscle activity in the neck and scapular area. Sixty-six participants performed a fixation task under three different conditions: binocular with minus lenses (-3.5D) and monocular with minus lens (-3.5D) and neutral lens (±0D). Ocular accommodation and trapezius muscle EMG were measured. Multiple regression analysis showed that response diopters accounted for 11.6% (p=0.009) of the variance in EMG in the binocular condition. In the monocular conditions, there were no significant relationships. 1. Introduction Poor visual ergonomics, such as poor lightning, poor eyeglass correction, and glare, impair visual comfort (Blehm et al., 2005, Yan et al., 2008). Among professional users of modern information technology, pain in the neck and scapular area and visual discomfort are common reported symptoms (Bhanderi et al., 2008). Results from Wiholm et al. (2007) indicate an association between self reported eye-strain and neck-shoulder symptoms and Helland et al. (2008) conclude that visual discomfort is associated with pain in the neck and shoulder area. The relationship between activity in ocular muscles and activity in neck and scapular muscles that stabilizes gaze is well known (Corneil et al., 2008, Tu and Keating, 2000). However, it is uncertain if ocular load per se contributes to increased muscle activity in the neck and scapular area. In 1987, Lie and Watten reported an increase in trapezius surface electromyography (EMG) as a function of ocular load. Since they were not able to measure the ocular response, the results are based on the assumption that the subjects complied with the task. In a more recent experimental study (Richter et al., 2011), subjects were stimulated to accommodate and converge by viewing a high contrast target, through trial lenses at different viewing distances. Trapezius muscle activity was measured with surface EMG and ocular response (accommodation) was recorded with an auto refractor. Under strictly controlled laboratory settings, high ocular response (accommodation) was associated with more activity in the trapezius muscles. It remains unclear if these results are applicable in real work life situations, and if ocular loads per se contribute to the development of work related musculoskeletal disorders in the neck and scapular area. Therefore, this study was designed with an occupationally more realistic fixation target and a lower and more realistic ocular load. 2 Objectives The aim of this study laboratory was to assess if ocular load similar to those that may occur in working life affect trapezius muscle activity, measured with EMG. 158

155 3 Methods 3.1 Subejcts Sixty-six subjects (54 females and 12 males), with a median age of 37 (range 19-47) performed a lab based experimental task under three different conditions. To avoid inclusion of subjects with eye disease, all subjects but three were examined by a registered optician. To ensure that the defocus stimulus during the experimental set-up was task-appropriate and similar for all subjects, ammetropias were measured in the laboratory with an auto refractor (Power Refractor R03, Plusoptix, Nürnberg, Germany) (Blade and Candy, 2006). Any detected spherical ammetropias (±0.25D) were corrected with trail lenses during the experiment. 3.2 Procedure During the experiment, the subject sat in an office chair in a dark room. The chair was adjusted to the subjects morphology and the head, neck, and back was supported. Due to the auto refractor, the subjects eyes had to be aligned to the camera and movements of the head, neck and trunk were not allowed. Therefore the subjects were instructed to keep the head, neck, and back supported. The same fixation task was used in all three conditions. The subject was instructed to focus on a zebra striped pattern (size 65 x 65 mm) on a computer screen. The computer screen was reflected with a cold mirror to make the recording with the camera possible (see figure 1). Viewing distance was 65 cm and the gaze angle approximately 15 downwards. Before the fixation task started, the contrast of the pattern was zero and the pattern was invisible to the subject. To start the task, the subject pushed a hand-held, low-force button and the contrast of the pattern increased (speed 0.8 units/s.). When the subject perceived the pattern, he/she pushed the button and the contrast froze for a short time. After the pause of random length ( s.) the contrast of the pattern decreased and when the pattern was invisible to the subject, he/she pushed the button. This was repeated throughout the task and the task continued for seven minutes. Figure 1. Model of the experimental set up. The participants performed the fixation task in three counterbalanced conditions. All three conditions were preceded by a three minute baseline when the subject rested with eyes closed. In each condition, defocus blur was introduced with lenses mounted in trial frames (Oculus Inc., Dutenhofen, Germany). For each subject and each condition, the condition lens spherical power was added to the on beforehand established spherical correction needed. The three different conditions were binocular minus (BM), condition lenses -3.5 diopters (D), monocular minus (MM), condition lens -3.5 D and monocular neutral (MN), condition lens ±0 D, i.e. only the correction needed. In the monocular conditions, a black lens was mounted in the trial frame in front of the non dominant eye. In the BM and MM condition, the spherical power of the condition lens was -3.5 D, together with the distance to the screen (1.5 D) the ocular load induced was 5 D. To overcome the induced blur in condition BM, and get a sharp image of the pattern, the subject were required to sustain contraction in the ciliary muscle corresponding to 5 D 159

156 change of optical power in the crystalline eye lens. In condition MN, the induced ocular load equaled the distance to the screen, i.e. 1.5 D. 3.3 Optometric and electromyography recordings Continuous sampling was made with an auto refractor (Power Refractor R03, Plusoptix, Nürnberg, Germany) during fixation task. The optometer records accommodation, convergence and pupil size at 25 Hz. The range of measurement for accommodation is -8.0 D to +6.0 D, with ±0.25 D accuracy, depending on pupil size and direction of pupil axes. The pupil size is specified in millimeters and the smallest pupil size the camera can detect is 2.8 mm. The recorded accommodation from the dominant eye was transformed into response diopters and used in the analysis. EMG was collected bilaterally from the descending aspect of the upper trapezius muscles with surface electrodes (Neuroline 725, Ambu A/S, Ballerup, Denmark). EMG signals were sampled continuously during baselines and fixation tasks at 2000Hz (EMG100C, Biopack Systems, Inc., Santa Barbara, CA, USA). EMG data were normalized to sub-maximal reference contractions and are expressed in %RVE (percent of the reference voluntary electrical activity) (Mathiassen et al., 1995). 3.4 Statistical analyses To ensure quality the raw data from the optometer and the EMG, all signals were visually inspected. Optometric data files with frequent artifacts, unstable data or less than 25% data from the dominant eye, were excluded from the analysis. Three subjects were excluded due to poor EMG signal quality. If the baseline EMG value of one trapezius (left or right) was higher than 2.5%RVE, that side was excluded and the analyses were conducted on EMG-values from the remaining side. In nine trials, both sides were excluded. Since the EMG data were not normally distributed, all EMG variables were transformed using the natural logarithm, inspected and tested for normality with Kolmogorov-Smirnov test. All statistical tests on EMG were run on a mean of left and right trapezius using the 10 th percentile log%rve. Descriptive statistics on EMG are specified in %RVE, 10 th percentile. Relationships between baseline EMG and fixation task EMG, and between fixation task EMG and response diopters were assessed using Pearson correlation. To evaluate the effect of accommodation on trapezius muscle activity, a multiple regression model was developed for each condition. The dependent variable was EMG during the fixation task and independent variables were baseline EMG and response diopters. Independent variables were entered in blocks, with baseline EMG in block one and response diopters in bock two. Statistical analyses were performed with PASW 18.0 for Windows (SPSS Inc., Chicago, IL, USA) and the significance level was α = Results 4.1 Descriptive statistics In condition BM and MM where ocular load was 5 D, the mean response diopters during the fixation task were 3.0 D (sd 2.0) and 3.3 D (sd 1.8) respectively. In condition MN where the ocular load was 1.5 D, the mean response diopters were 1.4 D (sd 0.5), see figure

157 Mean values of EMG in baseline (in %RVE, standard deviation in brackets ) preceding fixation task were 0.57 (0.47) in BM, 0.48 (0.37) in MM and 0.53 (0.50) in MN. Mean values of EMG during fixation task were 0.71 (0.62) in BM, 0.68 (0.52) in MM and 0.67 (0.67) in MN. 4.2 Correlation between variables In all three conditions, EMG in baseline and EMG during fixation task were significantly correlated, see table 2, model 1.In condition BM, the correlation between fixation task EMG and response diopters was 0.421, see figure 2 and table 1. In the monocular conditions, there were no significant correlations between fixation task EMG and response diopters, see table 1. Figure 1. Mean value of response diopters during fixation task in condition BM, MM and MN. Figure 2. Correlation between response diopters and fixation task EMG (log%rve) in condition BM. R=0.421, N=38. Table 1. Pearson correlation coefficients, R, within the three conditions. BM = Binocular minus, MM = monocular minus, MN = monocular neutral. N = 38 Baseline EMG Response diopters BM MM MN Fixation task EMG 4.3 Effect of accommodation on trapezius muscle activity Results of the multiple regression models in each condition are shown in table 2. In condition BM, response diopters accounted for 11.6% of the variance in EMG during the fixation task (p=0.009). In the monocular conditions, no significant relations between response diopters and fixation task EMG were shown (table 1). 161

158 Table 2. Results from regression analysis in the three different conditions. In each condition, the dependent variable was fixation task EMG (10 th percentile, log%rve). BM = binocular minus, MM = monocular minus, MN = monocular neutral. N = 38 Independent variable R R square (R 2 ) R 2 change p-value BM Baseline EMG Baseline EMG and response diopters MM Baseline EMG Baseline EMG and response diopters MN Baseline EMG Baseline EMG and response diopters Discussion The aim of this study was to assess if ocular load similar to those that may occur in working life affect trapezius muscle activity, measured with electromyography (EMG). The results revealed that in the binocular condition, there was a significant relationship that appears to be linear between increasing response diopters and activity in the trapezius muscles. The relationship remained significant after adjusting for baseline EMG activity. If the accommodation per se is the source of increased muscle activity in trapezius, the relationship would be expected to appear in the monocular minus condition (MM), where the accommodation load was the same as in the binocular condition (BM). One theory is that imbalance between accommodation and convergence is a relevant factor. This is shown in a study by Borsting et al. (2003) where individuals with convergence insufficience had a higher frequency of visual discomfort symptoms. Since the subjects eyes had to be aligned to the camera, the subject had to maintain the posture during the fixation task. Even though the office chair supported the head, neck and back and the subject were instructed to sit relaxed, the fixed posture could affect the trapezius muscle activity. Cagnie et al.(2007) found that sitting for a prolonged time was associated with neck pain. The posture instructions were the same in all conditions and it is unlikely that only the binocular viewing forces a change in the position of the head and neck, thus increasing activity in the trapezius muscles. In the study by Richer at al. (2011), the fixation target was placed 5 D away from the ageappropriate near point and the trial lens was -3.5 D. Mean age was 29 years and the age appropriate near point for a 29-year old person is 10 D, which corresponds to an ocular load of 8.5 D ( ). This study showed similar results in the binocular condition but with an ocular load of 5 D, regardless of the age of subject. Even though the ocular load was lower in this study, five diopters is still a high load. Five diopters equals a viewing distance of 20 cm and for most people doing near work, e.g. computer work, the visual target is at least 40 cm away. So for most people this load is higher than those at a computer, but the experimental load only lasts for seven minutes, while working time at a computer can continue many hours. The laboratory setting and exploratory aims of the present study make it difficult to imitate a realistic occupational situation. The high ocular loads, short experimental time, low EMG levels measured, and the instruction to subjects to sit in a fixed position differ from a typical working 162

159 conditions and therefore the results should be interpreted with caution. Despite the controlled setting, the findings suggest that together with other factors like stress and biomechanical load, ocular load may contribute to the development of near-work related neck/shoulder discomfort or pain. 6 References Bhanderi, D. J., Choudhary, S. & Doshi, V. G A community-based study of Asthenopia in computer operators. Indian J Ophthalmol, 56, Blade, P. J. & Candy, T. R Validation of the powerrefractor for measuring human infant refraction. Optom vis sci, 83, Blehm, C., Vishnu, S., Khattak, A., Mitra, S. & Yee, R. W Computer vision syndrome: a review. Surv Ophthalmol, 50, Borsting, E., Rouse, M. W., Deland, P. N., Hovett, S., Kimura, D., Park, M. & Stephens, B Association of symptoms and convergence and accommodative insufficiency in school-age children. Optometry, 74, Cagnie, B., Danneels, L., Van Tiggelen, D., De Loose, V. & Cambier, D Individual and work related risk factors for neck pain among office workers: a cross sectional study. Eur Spine J, 16, Corneil, B. D., Munoz, D. P., Chapman, B. B., Admans, T. & Cushing, S. L Neuromuscular consequences of reflexive covert orienting. Nat Neurosci, 11, Helland, M., Horgen, G., Kvikstad, T. M., Garthus, T., Bruenech, J. R. & Aaras, A Musculoskeletal, visual and psychosocial stress in VDU operators after moving to an ergonomically designed office landscape. Appl Ergon, 39, Lie, I. & Watten, R. G Oculomotor factors in the aetiology of occupational cervicobrachial diseases (OCD). Eur J Appl Physiol Occup Physiol, 56, Mathiassen, S. E., Winkel, J. & Hagg, G. M Normalization of surface EMG amplitude from the upper trapezius muscle in ergonomic studies - A review. J Electromyogr Kinesiol, 5, Richter, H. O., Banziger, T. & Forsman, M Eye-lens accommodation load and static trapezius muscle activity. Eur J Appl Physiol, 111, Tu, T. A. & Keating, E. G Electrical stimulation of the frontal eye field in a monkey produces combined eye and head movements. J Neurophysiol, 84, Wiholm, C., Richter, H., Mathiassen, S. E. & Toomingas, A Associations between eyestrain and neck-shoulder symptoms among callcenter operators. SJWEH suppl, 3, Yan, Z., Hu, L., Chen, H. & Lu, F Computer Vision Syndrome: A widely spreading but largely unknown epidemic among computer users. Computers in Human Behavior, 24,

160 TEMPORAL ASPECTS OF INCREASES IN EYE-NECK ACTIVATION LEVELS TRIGGERED BY VISUALLY DEFICIENT NEAR WORK Richter, H.O. 1 Lodin, C. 1 Forsman, M. 1,2 1 Centre for Musculoskeletal Research, U of Gävle, Sweden. 2 Division of Occupational and Environmental Medicine, Karolinska Institutet, Sweden. In an experimental study two levels of oculomotor load were induced via optical trial lenses. Trapezius muscle activity was measured with bipolar surface electromyography and normalized to a submaximal contraction. Sixty-six subjects with a median age of 36 (range 19 47, std 8) viewed a black and white Gabor grating (5 c/deg) for two 7-min periods monocularly through a 0 D lens or binocularly through -3.5 D lenses. The effect of time was separately regressed to EMG in two different subgroups of responders: a High-Oculomotor-Load (HOL) and a Low- Oculomotor-Load (LOL) group. A linear regression model was fitted on group level with exposure time on the x-axis and normalized trapezius muscle EMG (%RVE) on the y-axis. The slope coefficient was significantly positive in the -D blur condition for only the HOL subgroup of responders: Time min 1-7 x (p = 0.003, r 2 =0.850). There was no obvious sign of this activity to level off or to stabilize. These results suggest that professional information technology users that are exposed to a high level of oculomotor load, during extended times, are at an increased risk of exhibiting an increased trap.m. activity. 1. Introduction According to our research hypothesis, an increase in visual loads, due to deficient optical/physiological aspects of the near work (e.g., incorrect optometric correction or uncorrected visual error, deficient work station layout, insufficient rest periods, etc), causes not only eye symptoms, but may also give rise to a parallel increase in musculoskeletal load and symptoms in musculoskeletal effectors. This might be due to hard-wired sensorimotor reflexes and/or a generally very tight functional coupling from and between the eye-neck/scapular area effectors Richter et al. (2011). Recent work lend support for the idea that extended periods of large amplitudes of ocular accommodation, when the ciliary muscle is highly contracted, is coupled to a bilateral increase in static trap.m. activity level (Lodin et al., 2011, this volume). The previous results (Richter et al., 2010; 2011) show that increasing the tone of the ciliary muscle, by placing an optical minus lens in front of the eye and at the same time seeing to that the lack of focus incurred is compensated for by increasing eye-lens accommodation, was observed to be significantly coupled to a bilateral increase in trapezius muscle activity. These results suggested that sustained eye-lens accommodation has the ability to regulate gaze by triggering a postural stabilization response. The point of departure for the present study resides in the fact that the temporal aspects of exposure to deficient visual ergonomics so far have not been addressed. The accommodation/vergence system, when exposed to deficient optical/ physiological aspects of the near work, might exhibit different types of adaptive responses and/or time dependencies, each and one which theoretically could impact on the trapezius muscle activity in its own unique way. An increase in trapezius muscle activity could e.g. be associated with a declining accommodative response, a constant high level of eye-lens accommodation or a successive increase in eye-lens accommodation. The trapezius muscle activity similarly may exhibit a number of different dependencies on oculomotor load. It is of interest to learn more about the temporal patterning of such eye-neck/scapular area interactions. A secondary consideration in this context is that measurements under laboratory conditions by necessity are rather limited in time relative to realworld exposure conditions. Hence, any experimental musculoskeletal effects detected in the 164

161 laboratory, due to the deficient near work condition, should be extrapolated to more ecologically valid (i.e., more prolonged) exposure durations occurring in real life. Only then might it be possible to evaluate the magnitude of the musculoskeletal activation caused by oculomotor load in its own right. 1.1 Objectives The objective of the current laboratory study was to quantify the effects of 7 minutes of continuous exposure to high levels of oculomotor load on the magnitude and temporal patterning of eyeneck/scapular area interactions and to discuss exposure levels and durations occurring in real life in relation to the results. 2. Methods 2.1. Subjects Sixty-six participants (median age 36, range 19-47) participated in the study Optometric eye exam To avoid inclusion of subjects with eye disease, all subjects but three were examined by an authorized optician. To ensure that the defocus stimulus during the experimental set-up was taskappropriate and similar for all subjects, ammetropias were measured in the laboratory with an auto refractor (Power Refractor R03, Plusoptix, Nürnberg, Germany). Any detected spherical ammetropias (±0.25D) were corrected with trail lenses during the experiment Crystalline eye-lens accommodation Continuous sampling was made with the auto refractor during fixation task. The optometer records accommodation, convergence and pupil size at 25 Hz. The range of measurement for accommodation is -8.0 D to +6.0 D, with ±0.25 D accuracy, depending on pupil size and direction of pupil axes. The pupil size is specified in millimeters and the smallest pupil size the camera can detect is 2.8 mm. The recorded accommodation was transformed into response diopters Contrast sensitivity The subjects viewed a black and white Gabor grating (5 c/deg) Cambridge Research System) monocularly through a ±0 D lens or binocularly through -3.5 D lenses at a distance of 65 cm (1.54 D) for 7 minutes. The gaze angel was approximately 15 downwards. Individual Michelson estimates of contrast-sensitivity (L max -L min )/ (L max +L min )/were obtained in using the Bekéséy tracking method. Before the fixation task started, the contrast of the pattern was zero and the pattern was invisible to the subject. To start the task, the subject pushed a low forced button (hand held) and the contrast of the pattern increased (speed 0.8 units/s.). When the subject perceived the pattern, he/she pushed the button and the contrast froze for a short time. After a short pause of random length ( s), the contrast of the pattern decreased, and when the pattern was invisible to the subject, he/she pushed the button. This was repeated several times during the task that continued for seven minutes Electromyography recordings Electromyography (EMG) was collected bilaterally during baselines and fixation from the descending part of the upper trapezius muscle. The skin was cleansed with alcohol and rubbed with a fine cloth. Two disposable Ag AgCl electrodes (Neuroline 725, Ambu A/S, Ballerup, Denmark) were placed along the direction of the muscle fibers with a centre-to-centre distance of 2 cm. The electrodes were centred 2 cm lateral of the mid-point of the line connecting vertebra C7 and 165

162 acromion. Electrocardiography (ECG) was recorded to facilitate filtering of heart signal disturbances in the EMG signals. The EMG and ECG signals were amplified, band-pass filtered ( Hz) and sampled at 2000 Hz (EMG100C, BIOPAC Systems Inc., Santa Barbara, CA, USA). The EMG data were normalized to the root-mean-square (RMS) value of the middle 10 s of 15-s submaximal contractions (the reference voluntary electrical activity; RVE). During the reference contractions both arms were straight and horizontal in abduction (Mathiassen et al., 1995), which corresponds to 15 20% of a maximal voluntary contraction. The mean value of three repeated RVE contractions was used to normalize and express the measurement data in %RVE. The results of each minute were normalized to sub-maximal reference contractions. The EMG recordings were RMS-converted in 100-ms windows and quadratically adjusted for noise (the lowest 400-ms moving RMS value of a recording during relaxation). The 10th percentiles of each minute s RMS values were chosen as an indicator of muscular activity level. For more details see Richter et al., Procedure During the experiment, the subject sat leaned back in an office chair in a dark room. The chair was adjusted to the subject s morphology and the neck was supported. Because the eyes had to be aligned to the measurement axis of the optometer, movements from the neck/scapular area were not allowed. The participants performed the fixation task in two conditions, the order of which was counterbalanced between the subjects. These conditions were preceded by a three minute baseline when the subject rested with eyes closed. The subjects viewed the grating for two 7-min periods monocularly through a 0 D lens, i.e. only the correction needed (monocular neutral) or binocularly through -3.5 D lenses (binocular minus). In the monocular condition, a black lens was mounted in the trial frame in front of the non-dominant eye. In the binocular minus condition, the spherical power of the condition lens was -3.5 D, together with the distance to the screen (1.5 D) the ocular load induced was 5 D. To overcome the induced blur in this condition, and to get a sharp image of the pattern, the subject were required to sustain contraction in the ciliary muscle corresponding to 5 D change of optical power in the crystalline eye lens. In condition monocular neutral, the induced ocular load equaled the distance to the screen, i.e. 1.5 D Data processing Subjects were excluded due to poor EMG signal quality or failing refraction data. If the baseline EMG value of one trapezius (left or right) was higher than 2.5%RVE, that side was excluded and the analyses were conducted on EMG-values from the remaining side Statistical tests Respons-diopters and contrast-sensitivity across minute 1-7 data was first graphically analyzed. Growth rate in trapezius muscle EMG as a function of time and level of oculomotor load was assessed next using linear regression analysis. All statistical tests on EMG were run on a mean of left and right trapezius using the 10 th percentile %RVE. By dichotomizing the variable response diopters, an indirect measure of level of oculomotor load, a high and a low subgroup of oculomotor responders were created. The regression analysis was conducted separately on these two subgroups of responders. Statistical analyses were performed with PASW 18.0 for Windows (SPSS Inc., Chicago, IL, USA). 3 Results 3.1 Response diopters The group averaged amplitude of crystalline eye-lens accommodation across time during the monocular neutral condition ranged between (not shown). The averaged amplitude of 166

163 accommodation during the binocular minus condition ranged between D in the HOLgroup (N=24) and D in the LOL- group (N=26). See Fig Group average RD HOL-group (N=24) LOL-group (N=26) G roup aqveraged C S Time (minutes) T im e (m inutes) Figure 1. Left panel Averaged amplitude of eye-lens response in the binocular minus condition for the high and low subgroup of responders. Right panel averaged contrast sensitivity across the same two groups of responders. 5 Age was negatively correlated with response diopters during the binocular minus condition (r xy , p < ). The median age in the high oculomotor load subgroup of responders was 31 years (range 19-47) and 40 years (range 21-47) in the low oculomotor load subgroup. 3.2 Contrast sensitivity The group averaged amplitude of contrast sensitivity during the monocular neutral condition varied between (not shown). The group averaged amplitude of contrast sensitivity the minus blur condition ranged between (Fig. 1) and was highly correlated to response diopters, the later which accounted for % of the variance in the contrast sensitivity data (p < ). 3.3 Effect of eye-lens accommodation on trapezius muscle activity During the monocular neutral control a relatively small linear increase in EMG as a function of time could be observed across both subgroups of responders (p<0.05). In the binocular minus condition the HOL-group exhibited a linear increase in group averaged EMG magnitudes = Time min 1-7 x (p = 0.003, r 2 =0.850). There was no obvious sign of the group activity to level off or to stabilize. In contrast, the LOL-group exhibited a n.s. trend in their averaged EMG min 1-7 (p >0.05). See Fig

164 3 3 EMG (% RVE) 2 1 EMG (% RVE) Time (minutes) Time (minutes) Figure 2. Left panel Averaged trapezius muscle EMG across time during the monocular neutral condition. Right panel Averaged trapezius muscle EMG across time during the binocular minus condition (baseline EMG activity denoted in the lower left corner). Conventions as in Fig Discussion Response diopters during the monocular neutral condition on the average were task appropriate. The relatively tight relationship between response diopters and contrast sensitivity in the binocular minus condition was expected and provides a measure of internal validation of the data. The increase in EMG activity in the monocular neutral condition as a function of time suggests a small but systematic effect from the constrained sitting posture. The absences of a systematic increase in EMG activity in the low oculomotor load group during the binocular minus condition suggest that defocus blur per se does not give rise to EMG increases. The increase in EMG observed in the high oculomotor load group points to sustained eye-lens activity as a cause behind the EMG increases. Extrapolated group average EMG following simulated exposure up to 60 minutes was in the final analysis predicted for the two high oculomotor subgroups of responders using the parameter estimates obtained from the previous analyses. Predicted group average EMG activity following 60 minutes exposure in the HOL subgroup of responders were 6.03% (%RVE) (95% CI: ). See Fig

165 Predicted EMG (% RVE) HOL (+0 D blur) 95% CI Predicted EMG (% RVE) HOL (-3.5 D blur) 95% CI Time (minutes) Time (minutes) Figure 3. Left panel Predicted group EMG activity in the monocular neutral condition following extended exposure. Right panel Predicted group EMG activity in the binocular minus condition following extended exposure. The results together suggest that professional information technology users that are exposed to a high level of oculomotor load, during extended times, are at an increased risk of exhibiting an increased trap.m. activity. 5. References Mathiassen, S. E., Winkel, J., & Hägg, G. M Normalization of surface EMG amplitude from upper trapezius muscle in ergonomic studies A review. Journal of Electromyography and Kinesiology, 5, Richter, H. O., Bänziger, T., Abdi, S. and Forsman, M Stabilization of gaze: a relationship between ciliary muscle contraction and trapezius muscle activity. Vision Research, 23, Richter, H. O., Banziger, T. & Forsman, M Eye-lens accommodation load and static trapezius muscle activity. Eur J Appl Physiol, 111,

166 NECK SCPULAR AREA COMPLAINTS IN AGE RELATED MACULAR DEGENERATION PATIENTS. COMPLAINTS DUE TO OLD AGE OR TO DECREASED VISION? A CASE -CONTROL STUDY WITH AGE MATCHED CONTROLS. Zetterlund, Christina Ingrid (1,2); Lundqvist, Lars-Olov (2); Richter, Hans Olov (3) 1: The Low vision clinic Örebro Count Council, Sweden; 2: Center of reahbilitation research, Örebro Univerity Hospital, Sweden; 3: Center of musculoskeletal research, University of Gävle, Sweden 1.Introduction Vision is one of our most important senses that support other vital functions as proprioception, balance and motor control and thereby exercising effects on systems, which crucially affect everyday functioning and comfort. During the aging process, the body is subject of physical and neural decline, often resulting in many deficits and disorders. Age related macular degeneration (AMD) is the most common disease leading to low vision in the western world, where the prevalence involve every third person at the age of seventy. Observations from low vision clinics indicate that AMD-patients, besides their visual deficits, also describe musculoskeletal complaints, such as stiffness and muscular pain in the neck/scapular area and nausea and declined postural control 1-3 Most of these complaints are considered to be due to normal aging. With diminishing eyesight, decreased distance in near work situations and use of optical and technical magnification aids, patients with AMD and others with low vision may run a higher risk of straining the muscles in the neck/scapular area 4-6. Visual quality is typically disturbed by central visual field scotomas as in AMD, and is known to be of importance in order to maintain and calibrate proprioception Proprioception, our sensory feedback mechanisms for motor control and posture, has especially high input from neck scapular muscles interceptors 14, external eye-muscles interceptors 15 combined with visual feedback and extericeptors from the vestibular system, which all produces information to the brain, where a mental image of current body posture and environmental space is developed. Reduced proprioceptive acuity, due to inappropriate visual information may affect the integrity of eye-hand coordination, which in turn is associated with development of muscular fatigue and complaints 16, 17. Proprioceptive complaints are here understood as the miscalculations we make, in our normal daily work, which affect the tension in muscles due to a feeling of uncertainty. The effect on visual comfort and function following exposure to these and other musculoskeletal risk factors in AMD (and low vision in general), remain relatively unknown at present. 2. Objective The purpose of this study was to explore if reduced vision and proprioception is associated with neck/scapular area muscular dysfunction and/or discomfort, by investigating if subjects with low vision are more likely to express such problems compared to age-matched controls. 3. Methods Participants. Twenty-four AMD patients (AMD s) (10 males and 14 females) aged years (Mean = 76.5 and SD = 6.7) were compared with 24 age-matched controls with normal vision (13 males and 11 females) aged years (Mean = 73.7 and SD = 6.0). AMD s consisted of patients who had established their first 170

167 contact with the low vision clinic between 1998 and 2007, and who had consulted the low vision clinic at least twice or more before, which meant that we selected those who had adapted to their impairment. Visual Assessments. Visual assessments consisted of best distance and best near decimal Visual Acuity (VA) with assistance of their best correction. The Need for magnification, minimal readable print size and assisting aids were registered. All visual measurements refer to best possible visual performance, permitting binocular vision. Questionnaires Visual function. The National Eye Institute s Visual Function Questionnaire - Near Activities Subscale (NEI- VFQ-NAS) was used to assess the participants self-rated visual quality. Complaints. To obtain information concerning complaints from balance and proprioception, eyes and vision and neck scapular muscles, a new questionnaire was constructed. Five questions focusing on each of these areas were asked. Each question was answered on a visual analogue scale (VAS), ranging from 0 (no problem at all) to 10 (problems all the time), with verbal anchors at 3 (occasionally) and 7 (quite often). Statistical analysis. Independent samples of Mann-Whitney U-test were used in order to evaluate inter-group comparisons for all optical, functional and symptom measurements included in the study. Wilcoxon Signed Ranks Test was used for intra-group comparisons. Spearman s rho (ρ) was used for correlation analysis. In order to evaluate the most influential impacting factors on muscular complaints and to evaluate the influence of optical and visual factors, a stepwise (forward) multiple regression analysis with entry P < 0.05 and removal P > 0.10 was performed, using all the data from optical and functional measurements and remaining complaints. All statistical analyses were carried out using SPSS 15 for Windows (manufactured by SPSS Inc., Chicago, Illinois, USA). P-values less than 0.05 were considered significant (2-tailed). 4. Results The questionnaire s reliabilities were tested and resulted in a Cronbach s alpha of 0.81 for items concerning visual complaints, an alpha of 0.85 for muscular complaints and an alpha of 0.88 for proprioception, which all indicate adequate reliability 18. As expected AMD-patients had significantly lower results compared to controls in all visual parameters Median and inter-quartile range of visual assessment variables are shown in Table 1. Median score VFQ-NAS in the AMD patient group was significantly lower than in controls. VFQ - NAS in our study gave a Cronbach s alpha of TABLE 1 Results from optical assessment of AMD patients and age-matched controls Optical assessment variables AMD Controls Difference (Mann-Whitney U) Median IQR Mean IQR Z P Visual acuity at 4 m < Visual acuity at 40 cm < Reading distance (cm) <

168 Complaints Need of magnifying aid ( ) < Minimal readable font size (p) < Note. AMD = Age-related Macular Degeneration patients. IQR = Interquartile Range 1 Near visual acuity at 40 cm was estimated with the additional optical aid of +2.5 D. AMD AMR Complaints due to vision Complaints due to proprioception Muscular complaints in neck and shoulders Complaints due to vision Complaints due to proprioception Muscular complaints in neck and shoulders FIGURE 1. The box plots illustrate the results from The symptom questionnaire, each group separately. Maximum possible score from each area of complaints was AMD= Age-related Macular Degeneration patients The order to estimate the impact of visual deficiencies on musculoskeletal complaints three stepwise multiple regression analyses were performed. All variables (i.e. gender, age, group, optical assessments, VFQ-NAS, and symptomatic assessments) were regressed on each of the muscular complaints, balance/proprioceptive complaints, and visual complaints, respectively. The result of the three regression analyses are shown in Table 2. TABLE 2 Standardized coefficients from stepwise multiple regression analysis Independent variables Dependent variables Visual complaints Balance/proprioception complaints Muscular complaints Group Gender Age Visual acuity (distance)

169 Visual acuity (short distance) Minimal readable print size ** *** *** Binocular/Monocular Type of Aids Magnification Reading distance Pupil size VFQ-NAS * * Visual complaints *** Balance/proprioception complaints Muscular complaints *** Model R Note. = standardized regression coefficient. All are based on the final step in the regression analysis. in bold are statistically significant. Non-significant s are excluded from model R 2. * P < 0.05, ** P < 0.01, and *** P < Conclusion The results from this study suggests that visual and balance & proprioceptive complaints constitutes age independent effects on low vision. To our knowledge this is one of the first studies that have investigated the existence of a linkage between visual and musculoskeletal complaints. The strong co-variation between visual and musculoskeletal complaints in both groups confirms the hypothesis of an association between these areas of complaints. As the study is based on a cross sectional data collection we can only hypothesize about risk factors resulting in musculoskeletal complaints why further longitudinal studies are important prospects. Stepwise linear regression analysis identified self-rated visual quality (VFQ-NAS), to have the highest impact on balance & proprioceptive complaints. The combination of these results suggests that individuals with low visual acuity, who require larger print size, are more likely to experience complaints from neck/ scapular area muscles. 1. Brody BL, Gamst AC, Williams RA, Smith AR, Lau PW, Dolnak D, et al. Depression, visual acuity, comorbidity, and disability associated with age-related macular degeneration. Ophthalmology 2001;108(10): ; discussion Lee EK, Brennan M. Stress constellations and coping styles of older adults with age-related visual impairment. Health Soc Work 2006;31(4): Scheiman M, Sceiman,M., Whittaker,S.T. Low vision rehabilitation: A practical guide for occupational therapists. Thorofare: Slack incorporated; Gauthier GM, Robinson DA. Adaptation of the human vestibuloocular reflex to magnifying lenses. Brain Res 1975;92(2): Krueger H, Conrady P, Zulch J. Work with magnifying glasses. Ergonomics 1989;32(7): Richter HO. Eye-Neck/scapular area interactions during strenous near work.bialogical plausible pathways with relevance for work related musculoskeletal disorders of the neck and upper extremity. Zeitschrift für Arbeitswissenschaft 2008(62): Mon-Williams M, Burgess-Limerick R, Plooy A, Wann J. Vertical gaze direction and postural adjustment: an extension of the Heuer Model. Journal of Experimental Psychology: Applied 1999;5(1): Buckley JG, Heasley KJ, Twigg P, Elliott DB. The effects of blurred vision on the mechanics of landing during stepping down by the elderly. Gait Posture 2005;21(1):

170 9. Lord SRaM, Hylton B. Visual Contributions to Postural Stability in Older Adults. Gerontology 2000;46(6): Van Pelt S, Medendorp WP. Gaze-centered updating of remembered visual space during active whole-body translations. J Neurophysiol 2007;97(2): Grant AH. Factors influencing hand/eye synchronicity in the computer age. Optom Vis Sci 1992;69(9): Balslev D, Miall RC, Cole J. Proprioceptive deafferentation slows down the processing of visual hand feedback. J Vis 2007;7(5): Batista AP, Buneo CA, Snyder LH, Andersen RA. Reach plans in eye-centered coordinates. Science 1999;285(5425): Armstrong B, McNair P, Taylor D. Head and neck position sense. Sports Med 2008;38(2): Leigh RJ, Zee,D.S. The neurology of eyemovements. Philadelphia: F.A. Davis Company; Johansson H, Windhorst, U., Djupsjöbacka,M. & Passatore,M. Chronic work related myalgia. Gävle: Gävle University Press; McPartland JM, Brodeur RR, Hallgren RC. Chronic neck pain, standing balance, and suboccipital muscle atrophy--a pilot study. J Manipulative Physiol Ther 1997;20(1): Nunnaly JB, I., editor. Psychometric theory (3rd ed). New York: Mc Graw-Hill;

171 DIRECT MEASUREMENTS OF CILIARY AND NECK-SHOULDER MUSCLULAR ACTIVITY Forsman M. 1,2, Jansson U. 3, Lindström S. 3, Brautaset R. 3, Nilsson M. 3, Lodin C. 2, Richter H. 2 1 Division of Occupational and Environmental Medicine, Department of Public Health Sciences, Karolinska Institutet, Sweden 2 Centre for Musculoskeletal Research, University of Gävle, Sweden 3 Department of Neuroscience, Optometrics, Karolinska Institutet, Sweden A positive correlation between accommodation load and trapezius muscle activity has been reported under experimental conditions when subjects compensated for dioptric blur by tensing the ciliary muscle. In this experiment, eight healthy subjects focused on Near (10 D) and Far (1 D) targets and changed every 4th second. The subjects were fully corrected and the targets were presented under no blur viewing conditions. Median ciliary muscle activity (ECiG), and bilateral electromyography (EMG) from the upper trapezius and splenius capitis muscles were assessed. The ECiG was significantly different, p<0.0001, while the EMG levels were very similar for the two targets. The results do not support the existence of a direct short term connection between the ciliary and neck-shoulder muscles, which previously has been seen as one, among others, possible connections. Introduction Keywords: Visual ergonomics, Accommodation, Electromyography Work-related musculoskeletal disorders in the neck-shoulder are common problem among computer workers. In a Dutch longitudinal study including 264 computer users, the prevalence rates at start and the two year incidence was highest for neck and shoulder symptoms, (31% and 33% respectively; Eltayeb et al. 2009). Both physical (as computer work time), and psychosocial risk factors (as job demands) were found to predict neck and shoulder complaints. A recent review by Waersted et al on musculoskeletal disorders verified by physical examinations showed limited evidence for a causal relationship between computer work per se and computer mouse time related to tension neck syndrome. In a cross-sectional study of employees at 28 different call-centers, Wiholm et al. (2007), 46% of the 1162 questionnaire responders reported neck-shoulder symptoms, about half of these also reported eyestrain; a significant positive association was found between eyestrain and neck-shoulder symptoms. Helland et al. (2008) investigated lightning and neck and shoulder disorders among 34 computer worker before and after moving to an office landscape with large windows behind the visual display units (VDUs). Visual discomfort increased, and explained 53% of the variance in the neck and shoulder pain; a significant relation. The physiological mechanisms for development of these disorders, e.g. myalgia and tension neck syndrome, are not yet fully understood. According to Cinderella hypothesis, the low-threshold motor-units are the first ones to be at risk for selective overuse, e.g. causing fibre injuries, in a sustained muscle 175

172 activation. Hence, a small increase of the static muscular activity may increase the risk of motor-unit overuse. Visual discomfort (e.g., as due to glare, optical blur, or inappropriately sized or located visual targets) may be one factor, among others, that causes a small increase in muscular activity, and contributes to the generation of MSDs. Lie and Watten (1987) reported significantly increased muscular activity in the trapezius muscle (and four other muscle, including splenius or neck ) in an experiment of different loads of accommodation. A connection between the ciliary and trapezius muscles (see e.g. Richter et al. 2005), could possibly be a link between visual discomfort and MSDs. In our previous study Richter et al. (2011), we used four conditions of different lenses. Twenty-eight subjects viewed a target in two five-minute-periods per condition. The subject's ability to compensate for the lenses added blur was extracted via infrared photorefraction measurements. Subjects who showed a high accommodative response also showed a higher static trapezius muscle activity level. Hence, there was a correlation between mean accommodation load (or indirectly measured ciliary muscle load) over five minutes at Near and trapezius muscular activity. Since the ciliar activity was measured indirectly, and the periods of static ocular load were 5 minutes, it was not possible to conclude if this was a direct effect, within a second, effect that actually depend on the ciliary load, or a slower indirect effect. The activity of the ciliary muscle (which is a smooth muscle) is possible to measure, and it has been measured before, but to our knowledge such measurements have not been reported since 1966 (Adel, 1966). Objectives The purpose of this study was to reinvestigate the possibility to conduct ECiG measurements of the ciliary muscles and to use measurements of muscular activity to investigate the possibility of a direct connection between the ciliary, and trapezius and splenius muscles while alternating between unblurred high and low ocular load targets. Materials and Methods Subjects Eight subjects (4 men and 4 women, aged years) participated, after informed consent, in the study. To be included subjects also needed to be able to accommodate from 100 cm to 10 cm with or without correction regardless of age. The subjects had no history of eye diseases or neck problems. Neither did they take any medications affecting the eyes. Further, their corrected visual acuity was 20/20 or better. They had normal amplitude of accommodation for their respective ages, a normal near point of convergence of at least 10 cm, and no uncorrected toric refractive errors exceeding 0.75 D. Procedure During the trial the participant sat relaxed on a chair with supported chin, and accommodated Near (10 cm, 10 D) for four s and then shifted focus to Far (1 m, 1 D), four s. The test continued in this way for 2 minutes, and was performed twice. Two other distances (7 and 4 D) were included in further test periods, but those are not reported here. The set-up is shown in Figures

173 Figure 1. The experimental set-up. Signs were line-up in front of the left eye at 10, 7, 4,and 1 D, the font size was adjusted to distance. Only the two periods when the subject altered between Near (10D = 10 cm) and Far (1 m = 1 D: the 1 D sign is outside the picture to the right) are included in the present analyses. Physiological measurements The subjects were administered with a local anaesthetics (three drops of lidocain 4.0 %), before a Burian- Allen electrode was placed in the subjects' left eyes. The Burian-Allen-electrode was used to record an electrociliogram (ECiG). The ring receives electrical signals from the ciliary muscle whilst the silver wings serve both as a reference and to hold the electrode in place. A ground electrode was placed behind the ear to equalize the electrical potential between body and amplifier. The signal was amplified, bandpass filtered ( Hz) and sampled with 1000 Hz. Figure 2. Measurements of muscular activity of the ciliary muscle, and neck-shoulder muscles. The subjects were administered with a local anaesthetics (three drops of lidocain 4.0 %) The activity of the ciliary muscle, electrociliogram (ECiG), of the left eye, was measured with a Burian-Allen-electrode, commonly used in clinical electroretinograms. As shown in Figure 2, the ring electrode was on the cornea close to the ciliary muscle, while the silver coated wings served both as a reference and to hold the electrode in place. A ground electrode was placed behind the ear. The left eyes were occluded in order to prevent a blurry image and diplopia. The signal was amplified, band-pass filtered Hz (hence the DC part of the signal was deleted to increase the signal-to-noise ratio), and sampled with 1000 Hz. Surface electromyography (EMG) was measured bilaterally from the descending trapezius muscle, and from the splenius capitis muscle. Disposable Ag-AgCl electrodes were attached after the skin had been wiped 177

174 Right Trapezius EMG RMS (%MVE) ECiG (normalised) with alcohol (Figure 1). Two electrodes were placed on each upper trapezius, 2 cm laterally of the midpoint between vertebra C7 and acromion (Mathiassen et al. 1995). The signals were amplified, low-pass filtered (400 Hz), and sampled at 1000 Hz. For normalization purposes three maximum voluntary contractions (MVCs) were performed, combined for the left and right trapezius, and per each muscle of the left and right splenius. During the experiment the subjects left eye was video recorded, to enable confirmation of the subject s compliance with the task. Data analyses The raw sampled ECiG and EMG signals were visually inspected for quality. Median values of the ECiGs, of adequate quality, from 2 s per period ( s after the changed focus) were computed, as well as medians from the 15 Near and Far periods respectively. Medians of 0.1s root-mean-square (RMS) values from the trapezius muscles were computed in the same way. The neck/neck shoulder muscles were firstly normalized to the maximum voluntary electrical activity (MVE), which was computed as the maximum 1-s moving rms value from the corresponding MVCs. For comparison between the Near and Far muscular values, the indivual s median values were normalised to the individual s Far values, and group mean values were computed. Thus after normalization all Far values equaled one. Paired t-tests were carried out in Excel (Microsoft Office Professional Plus 2010) to test differences between Near and Far for ECiG and EMG (trapezius and splenius muscles). All data processing were done within MATLAB (version 7.11). Results The signal quality of the ECiG varied, but for seven persons at least one trial for each person was of satisfying quality. An example of nearly raw ECiG data, and RMS transformed EMG from the right trapezius muscle is shown in Figure 2. It was confirmed from the video-recordings that the short, sometimes sharp, artifacts in the ECiG signals appear when the right eye moved while altering focus (sometimes also with a blinking), so most likely these are due to movements also at the measured left eye. Since for each Near/Far period the median value s after the changed focus was computed, these artifacts should not affect the analyses results. 2 Near Far Near Far Near Far Near Far Near Far Near Far Near Far Near Far Near Far Near Far Time (s) 178

175 Figure3. Forty seconds from a trial. Upper diagram: ECiG signal from the left ciliary muscle normalised in amplitude to the Far periods. Lower diagram: simultaneous EMG RMS from the right trapezius. The EMG trace in Figure 3 is typical for the EMG measurements; the trapezius and splenius EMG levels were low and there were no visual difference between the Near and Far targets. The mean levels of the MVE normalized EMG (n=7) for the four muscles: left and right trapezius, and splenius ditto were: 0.37, 0.53, 2.10, and 1.52 %MVE. The mean values after normalization to the amplitude at Far is shown in Table 1. When normalizing in this way, i.e. dividing with the amplitude of the Far value, for each person, all Far EMG RMS values becomes 1, and the ECiG Far value becomes -1. There was a significant different between Near and Far for ECiG (p<0.0001), but not for the neck-shoulder muscles. Table 1. The mean and range values (n=7) after normalisation to the amplitude of Far. The difference between the two targets and the p-value of comparison is shown in the rightmost columns. Musclular activity Far Near Difference Paired t-test Normalised to ampl. of Far Mean Mean Range Near - Far p-value Electrociliogram (ECiG) ( ) 1.90 < EMG RMS left trapezius ( ) EMG RMS right trapezius ( ) EMG RMS left splenius ( ) EMG RMS right splenius ( ) Discussion In a few previous studies increased activity in the neck-scapular area muscles have been associated with an increase in crystalline eye-lens accommodation load. This study was performed to investigate the possibility of a direct connection between the ciliary and two neck-shoulder muscles under a high load conditions (10 D) of no defocus blur. The results of this experimental study do not support the existence of direct connection between the ciliary and the trapezius or splenius muscles; the EMG RMS difference between the Near and Far targets was very small. Previous works have indicated the possibility of such a connection, beside other possible connections. There were problems with the ECiG signal. Figure 3 shows eye motion artefacts. There were sometimes also low signal amplitudes that excluded signals from further analyses; We suspect that there easily could be a very low resistance, close to short-cut, between the two input terminals, one at the cornea and the other at the eye-lids. Still in seven of eight subjects the signals was of sufficient quality, and a very clear and significant difference was seen in the ciliary muscle activity signal between the Near and Far conditions. The used electrode was not optimised for ECiG, and more work is necessary in order to improve the quality of the ECiG signals. Although it is hard or impossible to statistically prove a non-existence, the lack of support of a direct connection under the present conditions, may be interpreted as a suggestion of a more indirect and slow connection. Lie and Watten (1987) also saw, for some subjects an increase of the muscular activity with time. The question of a possible slow indirect association, i.e. if a poor visual condition with time may increase the neck-shoulder muscular activity, remains to be focused. 179

176 Acknowledgements: The positive participation of the subjects is greatly acknowledged. References Adel, N.L Electromyographic and Entoptic Studies Suggesting a Theory of Action of the Ciliary Muscle in Accommodation for Near and Its Influence on the Development of Myopia. Amer. J. Optom. 43: 27-38, Eltayeb, S., Staal, J.B., Hassan, A., de Bie, R.A Work related risk factors for neck, shoulder and arms complaints: a cohort study among Dutch computer office workers. J Occup Rehabil. 19(4): Helland, M., Horgen, G., Kvikstad, T. M., Garthus, T., Bruenech, J. R. & Aaras, A Musculoskeletal, visual and psychosocial stress in VDU operators after moving to an ergonomically designed office landscape. Appl Ergon, 39, Lie, I. & Watten, R. G Oculomotor factors in the aetiology of occupational cervicobrachial diseases (OCD). Eur J Appl Physiol Occup Physiol, 56, Mathiassen, S. E., Winkel, J., & Hägg, G. M Normalization of surface EMG amplitude from upper trapezius muscle in ergonomic studies A review. Journal of Electromyography and Kinesiology, 5, Richter, H. O., Banziger, T. & Forsman, M Eye-lens accommodation load and static trapezius muscle activity. Eur J Appl Physiol, 111, Richter, H.O., Andersson, J., Schneider, H., Långström, B Neuroanatomical correlates of voluntary inhibition of accommodation/vergence under monocular open-loop viewing conditions. Eur. J. Neurosci. 21, Waersted, M., Hanvold, T.N., Veiersted, K.B Computer work and musculoskeletal disorders of the neck and upper extremity: a systematic review. BMC Musculoskelet Disord. 29;11:79. Wiholm, C., Richter, H., Mathiassen, S. E. & Toomingas, A Associations between eyestrain and neckshoulder symptoms among callcenter operators. SJWEH suppl, 3,

177 D2: PROMOTION OF HEALTH, SAFETY AND WELLBEING AT WORK D2.1 Work-related well-being in small-scale enterprises - the supporting role of occupational health services? Hannu Virokannas D2.2 The work-related and individual factors associated with work ability in the field of teaching Johanna Ekola D2.3 Elaboration of the prevention packages: a pre-defined process to prevent physical and mental wear and tear within the 'construction industry' and the 'day-care and domestic care sector' Charlotte Rasmussen D2.4 The relationship between job well-being and performance Timo-Pekka Uotila D2.5 Wellbeing at work card training Pirkko Mäkinen 181

178 WORK-RELATED WELL-BEING IN SMALL- SCALE ENTERPRISES THE SUPPORTING ROLE OF OCCUPATIONAL HEALTH SERVICES? Virokannas H. 1,2, Pyrrö P. 2, Ala-Mursula L. 1, Utriainen K. 1 1 Institute of Health Sciences, University of Oulu, Box 5000, FI Oulun yliopisto, Finland 2 Työterveysverkko Ltd., Metsolankuja 3 B 8, FI Tampere, Finland Abstract Small-scale enterprises (SSEs) (< 50 employees), play an important role in the Finnish economic life. In Southern Finland, an internet-based survey was sent to 245 managers of SSEs, current customers of municipal occupational health services (OHSs). Results were obtained from 97 managers (40 %). High level of well-being at work was related to perceived high usefulness of the OHSs, specifically in supporting health and work ability of the employees, in individual health check-ups as well as in providing support to managerial work. The results support the assumption that OHSs can be used to promote work-related well-being in SSEs. Keywords: usefulness of OHS, small-scale enterprise, work-related well-being 1. Introduction Small-scale enterprises (SSEs) employing less than 50 employees play an important role in the economic life in many countries. Also in Finland, the vast majority (99%) of all enterprises are small. Altogether employees work in small enterprises. In Finland, all enterprises regardless of their size (employing at least one person), are obliged to have a contract with an occupational health service (OHS) providing organization since a revision of the Occupational Health Care Act in As HR professionals and well-being experts are only rarely being employed within small enterprises, it has been suggested, that the OHSs could play an especially important role in promoting work-related well-being in these settings. In practice however, the arrangements of OHSs to SSEs appear insufficient or problematic in most countries (Rantanen 1994, Kirsten 2009). For example, workplace examinations have taken place more rarely in SSEs than in bigger workplaces, also the level of co-operation with OHS as well as the received information on health risks given by OHS have been poorly rated by the SSEs (Hyytiäinen 1998). As SSEs on the other hand tend to have poor resources for promoting occupational health themselves, notable problems are often found in their physical and chemical working conditions as well as ergonomics (Bergström 2004). Even the employees health and lifestyle habits may be worse in SSEs than in large-scale enterprises (Kubo 2006, Hoshuyama 2007). The assessments of the OHSs on the conditions in SSEs have varied widely (Muto 2000, Pakkala 2004). However, also positive examples of successful OHS interventions in reducing work injuries in small businesses have been reported, as reviewed by Breslin et al. (2010). There are many definitions of work-related well-being, taken as a positive concept, not merely as an absence of ill-being (Anttonen 2009, Hakanen 2004). No univocal definition exists so far. In the context of OHSs, the promoting of work-related well-being has been attached to a wide spectrum of activity at the work place. Such activities have been aimed, for example, at promoting positive development of work environment, work organization, the functioning of work community and leadership, employees professional know-how, as well as at the traditional promotion of workplace health and safety and promotion of health at individual level (Rautio 2010). 182

179 2. Objectives The object of this study was to explore the insights of SSEs on the importance of work-related wellbeing in general as well as factors contributing to it, with a special reference to the experienced role of OHSs in promoting well-being at work. 3. Material and methods In Pirkanmaa region in Southern Finland, an internet-based survey was sent in spring 2010 to 245 managers of SSEs (< 50 employees), current customers of three municipal OHS organizations. Results were obtained from 97 managers (40%). The managers were asked to rate their considerations on workplace conditions and needs related to well-being on a visual analogue scale (VAS) The rating 100 indicated totally agree or very high, and the rating 0 correspondingly totally disagree or very low. Similarly, the managers were requested to evaluate the perceived benefits for their organizations from specific OHS actions using VAS The SSEs were grouped into three categories according to the manager s ratings on the level of work-related well-being, and the differences between the groups were statistically tested by analyses of variance. 4. Results 4.1 The needs of the SSEs Nearly half of the managers (48 %) reported having challenges and developmental needs (VAS>50) emerging from changes in the environment. A third of the managers (33%) articulated needs for developing internal co-operation and meeting practices, 42% also on developing internal service chains. The level of work stress was considered high enough to tackle efficiency at work by 29% of the managers. Problems in the employees managing with the work load were recognized on 40% of the workplaces, severe problems (VAS >75) in 15%, respectively. Nearly half of the managers (47 %) reported a need for guidance on healthy life style and exercise. The ratings of co-operation between SSEs and OHS were divided into four levels, whereof nearly half (49 %) of the managers put their ratings on the lowest level indicating situations where the co-operation with OHS was limited to a minimum level of legally obliged health-related actions. In cases where co-operation was rated higher, the managers reported that co-operation with OHS specifically provided practical help in managerial problem situations (24%), or a generally supporting role for the SSE s organization (17%), or even deeper co-operation (10%). 4.2 Work-related well-being Nearly all of the managers (93%) considered the importance of the level of work-related well-being as very high or high for their businesses. Based on the level of actual work-related well-being (rated on VAS 0-100), the workplaces were divided into three categories of low (<61), medium (60-78) and high (>78) work-related well-being. The ratings of work-related well-being were higher in the groups of low time pressure and low level of work stress (p=0,005) and also in the group where high level of internal co-operation at the workplace was reported (p=0,001). The amount of challenges emerging from environmental changes was not significantly related to work-related well-being. If the level of co-operation between SSEs and OHS was low, the level of well-being at work was low (p=0.001). The high level of work-related well-being was significantly related to high level of work ability among the personnel (p=0.01) as rated by the managers. 183

180 4.3 Perceived benefits from OHS In terms of overall benefiting from various specific OHS actions, the managers gave highest ratings to medical services (mean/sd 62.1/23.6) and second highest ratings to health check-ups (mean/sd 58.8/24.2) provided by the OHS. In terms of benefits for specifically work-related well-being from specific actions of OHS, rated by the managers, high level of work-related well-being was correlated to the supporting actions of individual-level work ability, to individual health check-ups as well as to providing support to managerial work (Table 1). The benefits from OHS actions performed at workplace were rated somewhat less beneficial. Table 1. Perceived benefits from specific OHS actions to well-being at work rated by managers on VAS 0-100, mean (SD) Level of work-related well-being Perceived benefit Low Medium High P-value from spesific OHS Supporting work 39.0 (20.7) 51.8 (19.1) 58.0 (28.9) * ability Health check-ups 46.9 (21.5) 59.6 (22.3) 62.6 (27.7) * Supporting the 35.7 (22.8) 44,0 (22.3) 50.0 (27.9) functioning of work community Supporting 35.7 (21.3) 47.0 (27.5) 54.0 (25.9) * managerial work Medical care 50.5 (22.0) 65.3 (21.6) 64.1 (26.6) Actions at the workplace 42,6 (26.2) 49.3 (27.1) 61.3 (27.9) In SSEs with high well-being, the managers rated their perceptions of both the good acquaintance with the workplace (p=0.017) and expertise (p=0.017) of OHS higher than in the other categories. Also the overall satisfaction with OHS was higher (p=0.005) when well-being at work was high compared to the situations where it was low. 5. Discussion Although the overall coverage and the quality of OHSs have been rated high in Finland (Manninen 2007), it has also been noted, that the provision and focusing of OHSs to meet the needs of SSEs has remained problematic. At the same time, small enterprises are not too well aware of OHS practices and possibilities available (Pakkala 2004, Virokannas 2005). In this study, we aimed to deepen the knowledge concerning the actual level of work-related well-being in small enterprises, with a special reference on the possibilities of OHS in promoting well-being. We examined work-related well-being using ratings given by the managers, and compared enterprises in relation to the level of well-being at work. We found small enterprises with both very high and very low levels of work-related well-being. Such large variation may well have been a background for inconsistent results on the effects of OHS on small enterprises also in previous studies (Hyytiäinen 1998, Breslin 2010). The needs for support that the managers articulated in SSEs, are included in the areas of expertise of OHS, such as comprehending workplaces in changes and supporting in changes, development of internal co-operation, coping with work stress and managing with work load. However, the actual delivery of such services is unlikely when the mutual co-operation between OHS and SSE is on low level. In this study, half of the enterprises reported OHS only being active with the legally obliged minimum type of services. In such situations, contacting from OHS to SSE and vice versa remains 184

181 scarce. In this study we found, that in such cases also the level of work-related well-being was lower than in the case of active OHS co-operation. Most enterprises held work-related well-being important, but the perceived actual levels of wellbeing varied greatly and could be categorized into three levels. High well-being at work was related to low level of work stress, good internal co-operation and good work ability of the personnel. Of all OHS services, medical care services were valued highest. Medical care is provided to 80% of all employees covered by OHS, resulting in 1.5 visits/ 100 employees yearly (Manninen 2007). In this study, medical care services were not quite significantly associated with well-being at work. Associations with well-being were found with and benefits were perceived from supporting work ability, health check-ups and from supporting managerial work. Using managers ratings was motivated with earlier evidence on the managers high impact on the employees health and well-being in small enterprises (Brosseau 2005, Moriguchi 2010). Our results are in line with this assumption. A manager is a key agent in defining health needs of his/her enterprise and in focusing the co-operation with OHSs in order to provide benefits to the workplace. The key issue enabling OHSs to success in promoting work-related well-being seems to be good acquaintance with the workplace and high level of expertise. Earlier, in the studied three OHS organizations only overall satisfaction with the services had been monitored, but no conversations focusing on perceived benefits and effects had been conducted so far. The response rate for these SSE managers was 40% and can be considered moderate in this busy group. Although caution is warranted in interpreting these results, our study supports the assumption that even small enterprises may well benefit from occupational health services. The current situation remains unsatisfactory, if a third of workplaces is in a need of acute actions to promote work-related well-being and if the benefits from OHSs are as modest in quantities as reflected by our study. However, we emphasize that the needs expressed and the support and expertise experienced in occasions of co-operation provide a positive and plausible platform for promoting well-being at work, also in SSEs. Improved planning for actions, active contacting and service development are called for. To conclude, this survey showed that managers in SSEs with high level of work-related well-being reported that they had gained more benefits of OHSs than their colleagues in SSEs with low wellbeing at work. The results support the assumption that OHSs can be used to promote work-related well-being in small-scale enterprises. 6. References Anttonen, H. & Räsänen, T Well-being at Work New Innovations and Good Practices. Finnish Institute of Occupational Health, Helsinki. Bergström, M. & Huuskonen, M Pientyöpaikat. In: Kauppinen, T., Hanhela, R., Heikkilä, P., Lehtinen, S., Lindström, K., Toikkanen, J. & Tossavainen, A. (Eds), Työ ja terveys Suomessa 2006 [Small-scale enterprises In: Work and workers health in Finland Summary in English]. Finnish Institute of Occupational Health, Helsinki. Breslin, F.C., Kyle, N., Bigelow, P., Irvin, E., Morassaei, S., MacEachen, E., Mahood, Q., Couban, R., Shannon, H., Amick III, B.C. & The Small Business Systematic Review Team Effectiveness of Health and Safety in Small Enterprises: A Systematic Review of Quantitative Evaluations of Interventions. J Occup Rehabil 20: Brosseau, L.M. & Li, S.Y Small business owners health and safety intentions: A crosssectional survey. Environmental Health: A global access science source 4:23. (http://www.ehjournal.net/content/4/1/23). Hakanen, J Työuupumuksesta työn imuun: työhyvinvointitutkimuksen ytimessä ja reunaalueilla. Työ ja ihminen, tutkimusraportti 27. [Summary in English]. Finnish Institute of Occupational Health, Helsinki. 185

182 Hoshuyama, T., Hino, Y., Kayashima, K., Morita, T., Goto, H., Minami, M., Sakuragi, S., Tanaka, C. & Takahashi, K Inequality in the health status of workers in small-scale enterprises. Occupational Medicine 57: Hyytiäinen, K., Järvisalo, J., Lind, J. & Mäki, J Työterveyshuollon toimivuus pientyöpaikoilla: koetut ja arvioidut kuormitustekijät työssä. Suomen Lääkäril 53; 12: Kirsten, W Making the Link between Health and Productivity at the Workplace A Global Perspective. Review Article. Ind Health 48: Kubo, N., Usami, T., Haruyama, Y., Muto, T., Kimura, K., Yukawa, S., Kimura, T. & Yamane, N Characteristics of lifestyle and health status of workers in small-scale enterprises in Japan. Ind Heath 44: Manninen, P Hyvä työterveyshuoltokäytäntö, STM, TTL. Moriguchi, J., Ikeda, M., Sakuragi, S., Takeda, K., Muto, T., Higashi, T., Weel, A. & van Dijk, F Activities of occupational physicians for occupational health services in small-scale enterprises in Japan and in the Netherlands. Int Arch Occup Environ Health 83: Muto, T., Takata, T., Aizawa, Y. & Mizoue, T Analysis of Japanese occupational health services for small-scale enterprises, in comparison with the recommendations of the Joint WHO/ILO Task Group. Int Arch Occup Environ Health 73: Pakkala, L., Kalanen, K. & Saarni, H Yrittäjät eivät tunne työterveyshuollon toimintaa syy yrittäjien vähäiseen työterveyshuollon käyttöön? Työterveyslääkäri no 2. Rantanen, J Health protection and health promotion in small-scale enterprises. In: Rantanen, J., Lehtinen, S. & Mikheev, M. (eds) Health protection and health promotion in small-scale enterprises. WHO/FIOH, Geneva/Helsinki, pp Rautio, M. & Husman, P Työikäisten terveyden edistäminen esimerkkejä työmenetelmistä ja toimintamalleista. In: Pietilä, A.M. (ed.) Terveyden edistäminen. Teorioista toimintaan. WSOYpro Oy, Helsinki, Virokannas, H. & Österman, M Seitsemän kunnan alueellinen työterveyshuolto. KTYL, Oulun yliopisto, Oulu. 186

183 THE WORK-RELATED AND INDIVIDUAL FACTORS ASSOCIATED WITH WORK ABILITY IN THE FIELD OF TEACHING Ekola, J 1, Järvelin-Pasanen, S 1 and Louhevaara, V 1 1. University of Eastern Finland, Faculty of health Sciences, School of Medicine, Department of Biomedicine, Ergonomics. P.O.Box 1627, FI70211 Kuopio, Finland The objective of this study was to find out work-related factors and individual characteristics which were associated with the perceived work ability in the field of teaching. The study was based on the theoretical frame work of the Work Ability House. The subjects comprised 50 teachers. They were formed equalized pairs according to age and gender. The sample with the mean age of 50 years consisted of 14 female and 11 male pairs. The study showed that the work-related factors and professional competence were associated with the Work Ability Index in teachers. Therefore, the developmental measures promoting work ability and well-being should be focused on the psycho-social work environment of the teachers. Keywords: Field of teaching, work ability, functional capacity, work load 1 Introduction The work ability is characterized by the balance between a worker's individual resources and demands of the work. The principal resources include health, capacities, competence and values. The theoretical framework of the work ability can be described as a construction with four floors applying multidimensional Work Ability House (Fig. 1). In the framework, health and physical, psychological and social capacity are the basic first floor elements of individual work ability. The second floor of the Work Ability House reflects professional competence referring to formal and tacit knowledge and skills. The competence has also a dimension for developing own work and acting in different work communities. Values, attitudes and motivation are in the third floor, and they regulate the balance between individual resources and work as well as between work and leisure time. The fourth floor is dedicated to work and its various environmental exposures and psycho-physiological load factors. The organization of the work, functioning of the work community and management are complex issues and difficult to conceptualize and assess (Ilmarinen 2006). The Work Ability Index (WAI) is a prevalent method to assess perceived work ability (Ilmarinen et al. 1997, Tuomi et al. 1998). The WAI is affected by several work-related and individual factors (Ilmarinen et al. 1997). Recently Bonsdorff (2011) reported that perceived poor work ability in midlife was associated with accelerated deterioration in health and functioning and remains evident after the 28- year of follow-up. Physical fitness decreases due to age which is one of the most significant predictors for the WAI (Ilmarinen, 2001, Robertson & Tracy, 1998). In order to have good results in the promotion of work ability it is important to define all factors affecting work ability in different occupational contexts, especially, when the impact of the age can be controlled. 187

184 O ccupational health care O ccupational safety Society F am ily C lose com m unity W O R K A B IL ITY W ork W ork conditions W ork content and dem ands W ork com m unity and organization Supervisory w ork and m anagem ent V alues A ttitudes M otivation P r ofession al com peten ce H ealt h, F u n ct ion al C apacit y Figure 1. The Work Ability House (Ilmarinen, 2006). 2 Objectives The objective of this study was to find out work-related factors and individual characteristics which were associated with the perceived work ability in the field of teaching. The study was based on the theoretical frame work of the Work Ability House. 3 Methods 3.1 Subjects The subjects were 50 teachers (22 men and 28 women). Their mean age was 50 (range 37-60) years. The subjects were divided into the groups according to the WAI. The group with the moderate WAI included the subjects who received the WAI score 37 whereas and the group with the excellent WAI had the WAI score 43.The subjects were compared in pairs derived from two age- and gender- matched groups according to their WAI: the group A had the excellent WAI with the mean of 45.0 (SD 2.0) points and the group B had the reduced WAI with the mean of 35.0 (SD 2.1) points. 188

185 3.2 Questionnaires Perceived work ability was assessed with the WAI which covered the following seven items: 1. Subjective estimation of current work ability compared with lifetime best (0-10 points), 2. Subjective work ability in relation to both physical and mental demands of work (2-10 points), 3. Number of diagnosed diseases (1-7 points), 4. Subjective estimation of work impairment due to diseases (1-6 points), 5. Sickness absenteeism during the past year (1-5 points), 6. Own prognosis of work ability after 2 years (1, 4 or 7 points), and 7. Psychological resources e.g., enjoying daily tasks, activity and life spirit, optimistic about the future (1-4 points). The score of the WAI ranges from 7 to 49, and is divided into four categories as follows: poor (7-27 points), moderate (28-36 points), good (37-43 points), and excellent (44-49 points) (Tuomi et al. 1998). Subjective burn-out and work-related stress were assessed with the Bergen Burnout Indicator (BBI) and the Workrelated Stress Questionnaire (WSQ), respectively (Näätänen et al. 2003, Elo et al. 1992). Work motivation, professional competence, organizing of the work and functionality of the work community were assessed using a questionnaire items with the scale from 0 to 10, having the endpoints of totally disagree and totally agree, respectively. 3.3 Resting values The resting values of cardio-respiratory system were recorded in a supine position in the laboratory. Diastolic blood pressure (DBP) and systolic blood pressure (SBP) were measured with the Omron M4 automatic device (www.europe.omron.com). 3.4 Physical capacity The body balance was tested with the functional balance test (Punakallio 2004). Muscle strength of the trunk flexors was measured with the repetitive sit-up test (Pollock & Willmore 1990). The assessments of the anthropometrics and body composition preceded the tests. The measurements were carried out in the laboratory. The aerobic capacity was assessed with the 2-km walking test (Laukkanen et al. 2000) on an indoor track of 400 m. 3.5 Statistical methods Descriptive statistics included the calculation of frequencies, means, standard deviations and ranges. The group differences were tested with the χ2 test or the t-test with paired samples. The level of significance was set at p <

186 4 Results The perceived BBI and WSQ scores of the group A with the excellent WAI were significantly lower than those of the group B with the reduced WAI (p=0.001 and p=0.001, respectively) (Table 1 and 2). Table 1. The questionnaire based results of the study: Bergen Burnout Indicator (BBI) and Work-related Stress Questionnaire (WSQ) in the group A with the excellent WAI and the group B with the reduced WAI. Group A (n= 25) Group B (n= 25) n (%) n (%) p BBI points No or mild burnout symptoms Fair or severe burnout symptoms a χ 2 -test 21 (84) 4 (16) 12 (48) 13 (52) a Table 2. The questionnaire based results of the study: Work-related Stress Questionnaire (WSQ) in the group A with the excellent WAI and the group B with the reduced WAI. Scale was 1-5. Group A (n= 25) Group B (n= 25) m ± SD m ± SD p a WSQ points 2.8 ± ± Perceived work environment 2.4 ± ± Stress and satisfaction to work 2.1 ± ± Factors regulating work 2.2 ± ± Need to develop work and to have 2.1 ± ± support a t-test with paired samples The group A had a better motivation to work (p=0.000) and professional competence (p=0,011). There were no significant differences between the groups in the functionality and organization of the work (Table 3). Table 3. The results of the questionnaires about work motivation, professional competence, organisation of the work and functionality of the work community with the scale of The group A with the excellent WAI and the group B with the reduced WAI. Variable Group A (n= 25) Group B (n= 25) m ± SD m ± SD p a Motivation 8.5 ± ± Professional competence 7.8 ± ± Organization of the work 7.3 ± ± Functionality of the work 7.9 ± ± community a t-test with paired samples There were no significant differences between the group A and B in the physical capacity (Table 4). 190

187 Table 4. The resting values of diastolic blood pressure (DBP) and systolic blood pressure (SBP), anthropometrics (Body mass index=bmi), 2-km walking test, sit up and functional balance in the group A with the excellent WAI and the group B with the reduced WAI. Variable Group A Group B n m ± SD (range) n m ± SD (range) p a DBP (mmhg) SBP (mmhg) ± 13 (64-127) 133 ± 21 ( ) ± 11 (69-106) 136 ± 16 ( ) BMI (kg/m 2 ) ± 4 (20-35) ± 5 (22 37) km walking test ± 20 (34 123) ± 20 (44 120) (index) Sit up (max rep.) ± 14 (6-50) ± 12 (4-50) Functional ± 6 (11-32) ± 6 (8-39) balance(s) p a, t-test with paired samples 5 Conclusions Thise study showed that the work-related factors and professional competence were associated with the WAI in teachers. Therefore, the developmental measures promoting work ability and well-being should be focused on the psycho-social work environment of the teachers. The present results supported the theoretical framework of work ability i.e., the Work Ability House although the WAI evaluates perceived individual work ability. On the other hand, the strict categorization of variables to work-related or individual ones is sometimes difficult regarding, for instance, to professional competence. The main present challenge is to keep older and also younger people at work. This requires much effort to promote health, work ability and wellbeing and their work-related and individual determinants. More studies on work ability and, particularly, on recovery are necessary. 6 References Bonsdorff, M.B, Seitsamo, J., Ilmarinen, J, Nygård, C-H., Bonsdorff, M.E. & Rantanen, T Work ability in midlife as a predictor of mortality and disability in later life: a 28-year prospective follow-up study. CMAJ, 183, Elo, A-L., Leppänen, A., Lindström K. & Ropponen, T Occupational Stress Questionnaire: User's Instructions, Reviews, vol. 19, Finnish Institute oh Occupational Health, Helsinki. Ilmarinen, J Aging workers. Occup Environ Med, 58, Ilmarinen, J Towards a longer worklife. Ageing and the quality of worklife on the European Union. Jyväskylä. Finnish Institute oh Occupational Health. Gummerus. Ilmarinen, J., Tuomi, K. & Klockars, M Changes in the work ability of active employees over an 11-year period. Scand J Work Environ Health, 23, Laukkanen, R.M., Kukkonen-Harjula, T.K., Oja, P., Pasanen, M.E. & Vuori, I.M Prediction of change in maximal aerobic power by the 2-km walk test after walking training in middle-aged adults. Int J Sports Med, 21, Näätänen, P., Aro, A., Matthiesen, S.B. & Salmela-Aro, K Bergen burnout indicator 15. Edita. Helsinki. Pollock, M.L. & Willmore, J.H Exercise in health and disease. Evaluation and prescription for prevention and rehabilitation. WB Sauders Co. Philadelphia. Punakallio, A Trial-to-trial reproducibility and test-retest stability of two dynamic balance tests among male firefighters. Int J Sport Med, 25, Robertson, A. & Tracy, C.S Health and productivity of older workers. Scand J Work Environ Health, 24, Tuomi, K., Ilmarinen, J., Jahkola, A., Katajarinne, L. & Tulkki, A Work ability index. Finnish Institute of Occupational Health, Helsinki. 191

188 (read 15th August 2011). 192

189 ELABORATION OF THE PREVENTION PACKAGES: A PRE-DEFINED CONCEPT TO PREVENT PHYSICAL AND MENTAL WEAR AND TEAR WITHIN THE CONSTRUCTION INDUSTRY AND THE HOME CARE AND RESIDENTAL CARE SECTOR. Rasmussen, C.D.N. MSc 1, Kvorning, L.K.V. MSc 1, Hasle, P. PhD 1 1 The National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark The Prevention Packages is a concept aiming at improving the working environment in high risk sectors in Denmark that are characterized by high prevalence of sickness absence and disability retirements. The Prevention Fund offers workplaces within specific sectors the possibility to apply for financial support to implement a Prevention Package. The intervention in each package is pre-determined and specified to reflect the most common occupational health and safety problems in selected high risk sectors. From January 2011 it was possible to apply for financial support to implement a Prevention Package for the 'construction industry' and the 'home care and residential care sector'. Keywords: occupational health; prevention; health promotion 1. Introduction Denmark is facing future challenges in the labor market concerning changes in demographics towards an ageing and shrinking workforce (Statistics Denmark 2010), similar to most other Western countries. Ageing, impaired work ability (Alavinia et al. 2009) and decline in health can contribute to early retirement from work (Alavinia, van Duivenhooden, & Burdorf 2007). To overcome these demographic consequences, there is a need to find means for maintaining work ability, especially in high-risk sectors with physical and mental wear and tear and thereby increased risk of early retirement from work. Therefore, interventions aimed at high-risk sectors for improving the working environment to decrease the risk of physical and mental wear and tear and promote health, may be an approach to maintain work ability. The Danish government has granted financial support aiming at reducing musculoskeletal disorders, improving the psychosocial work environment and promoting health in the high-risk sectors through predefined projects, called the Prevention Packages (PP). The background and conceptual model for the PP s has been described in details in the paper by Kvorning, Rasmussen and Hasle (Kvorning, Rasmussen & Hasle 2011). The PP s are developed by researchers from the National Research Centre for the Working Environment (NRCWE) in collaboration with the Danish Working Environment Authority (WEA) and reflect solutions to the most common occupational health and safety problems in the selected high risk sectors. From January 2011 it was possible to apply for financial support to implement a PP for the 'construction industry' and the 'home care and residential care sector'. This paper describes the content of the PP s for these two sectors. 2. Content of the Prevention Packages 2.1 Construction industry Construction workers are highly exposed to physical demanding occupational tasks, such as heavy lifting (Alavinia, Van Den Berg, Van Duivenbooden, Elders, & Burdorf 2009;Engholm & Holmström 2005). It is well documented that construction workers have a high prevalence of 193

190 musculoskeletal disorders, sickness absence and early retirement (Arndt et al. 2005;Engholm & Holmström 2005). The PP s specified to the construction industry reflect their occupational hazards and are aimed at 1) heavy lifting and use of technical aids, and 2) improved planning of working tasks in order to reduce occupational injuries as well as physical and mental wear end tear. The PP s aimed at the construction industry are exclusively for small enterprises ( 9 employees). Implementation of a package is planned to last three to six months. Besides receiving financial support, the workplace is offered a consultant from the WEA who will guide the workplace through the process. If needed, the employer can contact the consultant up to two months after the project has ended to discuss problems Heavy lifting and use of technical aids The aim of this PP is to give the company knowledge of relevant technical aids and how they can plan the use of aids in both short-and long-term projects. This allows the use of technical aids to become a natural part of the working tasks. The PP involves testing of a new technical aid for a longer period on relevant working tasks and includes financial aid to rent a technical aid during the process. A consultant from the WEA will guide the company through the process Improvement of planning This PP involves introduction and implementation of new planning tools to optimize the planning of daily working tasks and the planning of new projects. A consultant will guide the company through the process and in the development of an effective dialogue concerning planning of work tasks - a tool for work environment evaluation of tenders and work plans. Four different tools to systematically plan the work tasks are introduced: 1) kick-off meetings, 2) construction meetings, 3) toolbox meetings and 4) safety inspections. The package will potentially reduce the risk of physical wear and tear and improve the cooperation among all employees in the specific company and at the construction sites. 2.2 Home care and residential care Workers in home care and residential care are exposed to occupational heavy lifting and other demanding tasks (Skotte et al. 2002). Studies show that workers within home care and residential care have a high prevalence of musculoskeletal disorders, sickness absence and early retirement (Caruso & Waters 2008). Therefore these PP s are aimed at 1) reduction of work-related strain with the three residents considered the most demanding, 2) a future workshop aimed at improving the relationship with residents and their relatives, 3) colleague supervision in order to improve the relationships with residents and their relatives, and 4) organisation of occupational health circles in order to map and reduce physical and mental strain. Workplaces ( 65 employees) can apply for financial support to implement one of the four PP s lasting three to nine months. The workplace is offered a consultant from either the municipality or the region that will guide the employer and employees through the process The three residents considered the most demanding The aim of this PP is to improve the working environment, by optimized handling of challenges with resource-consuming residents and development of new ways to solve tasks, working better for residents as well as employees and thereby reducing the experiences of stressful situations. The focus is on specific resource-consuming residents using structured collegial dialogue and thereby helping employees to find new ways to solve daily working tasks. The nine workers that are most involved in the daily working tasks with the three most demanding residents are selected to form a working group and find new solutions by using collegial dialogue. This method helps employees to 1) identify daily tasks with resource-consuming residents, 2) understand the reasons why the task requires many resources, and 3) find new ways to perform tasks that make it easier and less costly 194

191 for both employees and citizens. A consultant will introduce structured methods of collegial dialogue aiming at solving problems related to the three selected residents A future workshop The aim of this PP is to give the employees more influence on their own work tasks, increase social support between employees and management as well as a more appropriate planning of the workday. The PP introduces new methods on how to take concrete action upon the new solutions by criticizing and optimizing the daily routines and formulate ideas and common goals (Skoglind- Ohman & Shahnavaz 2004). All employers and employees are invited to participate in the future workshop with a consultant. The future workshop consists of three phases and lasts two days: phase 1) a critique phase (½ day), where employees critically discuss what does not works in the daily work tasks, phase 2) a utopia phase (½ day), where employees formulate the ideal working environment with better contact and dialogue with residents and phase 3) a reality phase (1 day), with discussion of realization of the utopias by development of a concrete action plan Colleague supervision The aim of this PP is to build a working environment encouraging colleagues to 1) exchange experiences on difficult situations in encountering residents and their relatives, 2) achieve a better cohesion and getting acquainted with each other's and own skills. With guidance and support from the colleagues by discussing experiences during the working day the package will potentially help employees to 1) reflect on the daily challenges, 2) exchange experiences with colleagues about handling strategies, and 3) give and receive constructive feedback to/from colleagues. All sessions with collegial supervision begins with a short bout of physical exercises for creating a good atmosphere for colleague supervision Occupational health circles Health circle is an abbreviation of the word occupational health circles. The main aim of this PP is to organise occupational health circles in order to map and reduce physical and mental strain (Aust & Ducki 2004). Health circle is a method to systematically identify safety problems and find and implement appropriate solutions in practice. The method is based on employees' subjective experiences of the working environment and active participation. A health circle group is formed and typically consists of 1 consultant to manage the process, 6-8 employees, 1 union- and 1 safetyrepresentative and 2 managers. Throughout the process, the workplace will be conducting a series of concrete improvements in the psychosocial and physical working environment for reducing the risk of physical and mental strain. 3. Evaluation The content of the PP s are rather different, so to assess whether the PP s in general can be implemented and have an effect, an evaluation is designed based on mixed methods. Regarding outcome measures, the PP s will be evaluated with questionnaires at baseline and follow-up, containing validated questions on work-related factors (e.g. exposure to specific physical work tasks (Sandsjø et al. 2006) and psychosocial factors (Copenhagen Psychosocial Questionnaire (Kristensen 2002)), work ability (Tuomi et al. 1998) and perceived physical exertion (Borg 1970), as well as sociodemographic measures (e.g. age, sex, height, weight), lifestyle behaviour (e.g. smoking, physical activity (Saltin & Grimby 1968)), general health (SF-36) (Ware & Sherbourne 1992), musculoskeletal disorders (Kuorinka, Jonsson, & Kilbom 1987) and sickness absence (Labriola & Lund 2007). Implementation of the PP s will be evaluated by a process evaluation focusing on barriers and facilitators for implementation. Semi-structured interviews with the manager and a group of employees will be conducted at selected companies by a researcher from the NRCWE. Furthermore, all managers is asked to fill in a questionnaire at baseline and follow- 195

192 up concerning e.g. their expectations towards the implementation of the PP s, their opinion of the content and process of the PP s as well as the organisation of the company, the working environment and changes within the organisation which potentially could have an effect on the implementation. 4. Discussion The PP s is a completely new way of combining research and practice, where the best available evidence about ways to improve the working environment is used to create simple and effective interventions. Thus, the PP s have the potential to improve the working environment in sectors where there is a great risk of physical and mental wear and tear, as well as providing insight into new strategies for reducing physical and mental wear and tear. Additionally, the PP s offer the opportunity to study the process and implementation of pre-defined interventions in specific highrisk sectors, including problems with participation as well as anchoring and retention of the activities in a busy and changing work environment, especially within small workplaces. However, these PP s are standardised simple projects and may not match all worksites, which will be a challenge. Thus, it will be interesting to observe if the PP s can be adjusted to the needs of each worksite. In order to inform these high-risk sectors about the PP s, the labour unions and employers associations presented information through websites and newsletters, and supervisors from the Danish Working Environment Authority had a pamphlet about the packages to hand out on inspections. The first experiences with the PP s have been positive. The two high-risk sectors have shown a great interest in applying for a PP. Within the first 6 months approximately 125 companies within each sector has applied for a PP and been granted money to implement a package. Thus, the marketing of the packages has been successful. The PP s are currently implemented within the construction industry and the home care and residential care sector and will be evaluated by a process evaluation, in order to identify and understand possible barriers and facilitators to implementation of the PP s. The content of the packages will be adjusted according to the results of the process evaluation. Due to the simplicity of the PP s there is a great risk that the changes will be so small, that we cannot see an effect on health and improvement of the working environment. Also, the PPs are designed so simple, that the question is whether they are able to be anchored and sustain improvements after completion of the project. During the following two years, researchers from the NRCWE will, in collaboration with the WEA, develop PP s for more than ten other high-risk sectors particularly vulnerable to physical and mental wear and tear. These sectors include, among others, transport, cleaning, child care, restaurants and a number of manufacturing subsectors. These sectors will also have the opportunity to apply for financial support from the Prevention Fund. Thus, the PP s have the possibility to affect the working environment in many high-risk sectors in great risk of physical and mental wear and tear and sectors that are usually not offered workplace interventions (Grosch et al. 1998). The impact of The PP s can therefore be of substantial importance. References Alavinia, S. M., Van Den Berg, T. I. J., Van Duivenbooden, C., Elders, L. A. M., & Burdorf, A. 2009, "Impact of work-related factors, lifestyle, and work ability on sickness absence among Dutch construction workers", Scandinavian journal of work, environment & health, vol. 35, no. 5, pp

193 Alavinia, S. M., van Duivenhooden, C., & Burdorf, A. 2007, "Influence of work-related factors and individual characteristics on work ability among Dutch construction workers", The Effect of Work on Health and Work Ability, vol. 33, no. 5, p. 39. Arndt, V., Rothenbacher, D., Daniel, U., Zschenderlein, B., Schuberth, S., & Brenner, H. 2005, "Construction work and risk of occupational disability: a ten year follow up of male workers", British Medical Journal, vol. 62, no. 8, p Aust, B. & Ducki, A. 2004, "Comprehensive Health Promotion Interventions at the Workplace: Experiences With Health Circles in Germany", Journal of occupational health psychology, vol. 9, no. 3, p Borg, G. 1970, "Perceived exertion as an indicator of somatic stress", Scandinavian Journal of Rehabilitation Medicine, vol. 2-3, pp Caruso, C. C. & Waters, T. R. 2008, "A review of work schedule issues and musculoskeletal disorders with an emphasis on the healthcare sector", Industrial health, vol. 46, no. 6, pp Engholm, G. & Holmström, E. 2005, "Dose-response associations between musculoskeletal disorders and physical and psychosocial factors among construction workers", Scandinavian journal of work, environment & health, vol. 31, p. 57. Grosch, J. W., Alterman, T., Petersen, M. R., & Murphy, L. R. 1998, "Worksite health promotion programs in the U.S.: factors associated with availability and participation", Am J Health Promot, vol. 13, pp Kristensen, T. S. 2002, "A new tool for assessing psychosocial factors at work: The Copenhagen Psychosocial Questionnaire", Stress at Work, vol. 5, no. 5, p. 45. Kuorinka, I., Jonsson, B., & Kilbom, A. 1987, "Standardized Nordic questionnaires for the analysis of musculoskeletal symptoms", Appl Ergonomics, vol. 18, pp Kvorning, LKV, Rasmussen, CNR, & Hasle, P, "Background and conceptual model for The Prevention Packages: An initiative to prevent physical and mental wear and tear in small workplaces", Paper at NES Labriola, M. & Lund, T. 2007, "Self-reported sickness absence as an indicator of future disability pension. Prospective findings from the DWECS/DREAM study ", European Journal of Public Health, vol. 17, p. 47. Saltin, B. & Grimby, G. 1968, "Physiological analysis of middle-aged and old former athletes. Comparison with still active athletes of the same ages", Circulation, vol. 38, pp Sandsjø, L., Larsman, P., Vollenbroek-Hutten, M. M. R., Läubli, T., Juul-Kristensen, B., Klipstein, A., Hermens, H., & Søgaard, K. 2006, "Comparative assessment of study groups of elderly female computer users from four European countries: questionnaires used in the NEW study", European journal of applied physiology, vol. 96, no. 2, pp Skoglind-Ohman, I. & Shahnavaz, H. 2004, "Assessment of future workshops usefulness as an ergonomics tool", International Journal of Occupational Safety and Ergonomics (JOSE), vol. 10, no. 2, pp

194 Skotte, J. H., Essendrop, M., Hansen, A. F., & Schibye, B. 2002, "A dynamic 3D biomechanical evaluation of the load on the low back during different patient-handling tasks", Journal of biomechanics, vol. 35, no. 10, pp Statistics Denmark 2010, Statistical Yearbook Tuomi, K., Ilmarinen, J., Jahkola, A., Katajarinne, L., & Tulkki, A. 1998, Work Ability Index 2nd revised edn., Finnish Institute of Occupational Health, Helsinki, Finland. Ware, J. E. & Sherbourne, C. D. 1992, "The Mos 36-item short-form health survey (SF-36).1. Conceptual-framework and item selection", Medical Care, vol. 30, no. 6, pp

195 THE RELATION BETWEEN WELL-BEING AND PERFORMANCE Timo-Pekka Uotila, Riitta Viitala & Maria Järlström University of Vaasa, Department of Management, P.O.Box 700, VAASA, Finland. The aim of this paper is to review the literature on job well-being and performance. The paper presents an overview of the main concepts and the found relation between job well-being and performance based on articles from four academic journals between 2000 and Based on analysis clarification of concepts is still required. Some relationships can be identified from individual level well-being and individual performance. Still, more research is needed to explore the relationship between individual well-being and organizational performance. Key words: (job) well-being, performance. 1 Introduction Employee well-being has increased interest in academic research with variation of conceptualization of well-being (Danna & Griffin 1999; Robertson & Flint-Taylor 2009). Distinction between people s overall well-being (e.g. happiness) and specific domain of well-being, such as well-being at work (Diener et al. 1999) has been presented. Especially well-being at work, here referred as job well-being, has become a topic of interest for many management researchers during the last decade as it has consequential implications for both individuals and organizations. Mostly the phenomenon of job well-being is investigated through the concept of job satisfaction even though several other concepts are available. There is a belief that the job well-being of employees benefits the employer in many ways. One of reasons (or mediators) to positive organizational outcomes may be related to well-being employees attitudes and behaviors. For example Spector (1997) presents that more satisfied employees are more efficient, less absent, more committed, more punctual, more helpful and more cooperative to their work mates than less satisfied employees. Schmidt and Keyes (2002) in turn talked about positive workplace perceptions when they showed the associations with higher business-unit customer loyalty, higher profitability, higher productivity and lower rates of turnover. Hence, the impacts of well-being may be assessed at the organizational level as well. The aim of this paper is to review the literature on job well-being and performance. Firstly, a review to journal articles identifies the used concepts (and sub-concepts) in job well-being and performance research, and secondly, a short overview will be formulated about the relation between the two phenomena. After theoretical basis, an empirical part follows with the main results. The paper ends with discussion. 2 Well-being and performance Well-being can be approached from two perspectives: from a positive well-being and a negative unwell-being perspective. Although positive well-being has been raised up years ago, the most of the studies have concentrated on negative aspects of well-being, such as burnout. A positive well-being approach has increased interest in recent research, even though it is presented that positive wellbeing and negative un-well-being complement each other (Scaufeli & Bakker 2004). Job well-being is a broad category, which includes a number of individual and workplace factors. It is focused on 199

196 subjective experiences and functioning at work. At a general level, job well-being can simply be defined as employee s ability to manage his or her daily work. Factors like physical, mental and social condition of employee as well as working environment and work community are related to this ability. Job well-being is regularly empirically studied through concepts such as commitment, job satisfaction and work-life balance (Baptiste 2008). Job satisfaction is an important part in job wellbeing and defined as persons satisfaction or dissatisfaction to his/her job and to the factors, which are interrelated to the job (e.g. wage, colleagues). The base of job satisfaction is the employee s positive or negative feeling about his/her job (Danna & Griffin 1999; Ghazzawi 2008). Negative side of job well-being can be studied through workload or job strain, focusing on how heavy is the workload which individual perceive. Workload, or strain, can be physical (e.g. due to equipment or methods) or mental (e.g. due to amount or ease of work). The mental workload can be experienced when an employee feels that the demands of work (e.g. how fast work must be done or how many interruptions occur) are relatively higher than the employee s locus of control (i.e. the degree to which the employee has the required skills and knowledge to manage their work and the opportunity to control their work) (Karasek, 1979; Almost and Spence Laschinger, 2002:410). Number of studies confirm that the three most common factors involved in job dissatisfaction are work demands, lack of support, and lack of opportunity to control the work (Way and MacNeil, 2006). When work is mentally demanding over an extended period and the demands are strong enough, the employee is likely to experience stress (e.g. Love et al., 2007) which may bring broader problems like burnout (Maslach and Jackson, 1981). Researchers have proved the relationship between job satisfaction and work performance on the individual level (e.g. Wright & Cropanzano 2000; Judge, Thoresen, Bono & Patton, 2001). However, the limitation of job satisfaction is that it ignores other aspects of one s life (Wright & Bonett 2007). Because of several other concepts besides job satisfaction are used in well-being area, and because job satisfaction may be part of the other well-being constructs, the linkage between wellbeing and performance is less clear. Further, it is stressed that job well-being may be even more important for the organizational level outcomes (Robertson & Flint-Taylor 2009). The phenomenon of performance is even fuzzier. Sometimes researchers use a label of work performance or job performance, and sometimes they talk about productivity or effectiveness. The measures used are still undeveloped, even though both subjective and objective measures are used. There are different views on performance depending on the examined organizational level (individual, unit, organizational level performance) and the rater (employee and/or supervisor). One of the most often used ways to approach individual job performance is based on the model of Campbell, McHenry and Wise (1990). In their model job performance is seen as a behavior which is meaningful to organizational goals. Performance is divided into job-specific performance, which includes certain skills or behavior required in a certain job, and non-jobspecific performance, which includes general components which are similar in every job in organization, such as team work or continual self-development (Campbell et al 1990). Other, similar ways to divide performance are to divide it into in-role and extra-role performance (Becker & Kernan 2003). In addition of task performance also organizational citizenship behavior has been used to study performance in a holistic fashion (Podsakoff, MacKenzie, Paine & Bachrach 2000). Well-being related performance discussion on an organizational level is focused mostly on costs derived from unhealthy organization. Indicators that can be used to measure organizational performance include direct costs such as employee health care, sickness leaves, accidents, pension and personnel turnover and indirect costs such as presenteeism, decrease on employee efficiency and quality of products or services and the cost of lost innovations (Elo & Ervasti 2006). However, especially the objective measurement of indirect costs is difficult. 200

197 To conclude, because both of the researched topics - job well-being and performance - are developing, clarity of the concepts is needed in the field. 3 Method The sample of the study includes 14 articles from four academic journals: Academy of Management Journal, Personnel Psychology, Work & Stress and Journal of Occupational and Organizational Psychology. The journals were selected for a reason that they are well known journals with focus on phenomena in the area of both psychology and management. Relevant articles were searched by using EBSCO data base. The literature search was made with following keywords including wellbeing related terms, i.e. well-being, engagement, burnout, job satisfaction, job involvement, work passion and performance related terms, i.e. performance, profit, effect, productivity and outcome. The articles were selected based on the title and the abstract. For a paper to be included in this review it had to be empirically validated. Therefore, the conceptual papers were excluded from review (e.g. Inkpen & Tsang 2005). Finally five articles were chosen from each journal based on their supposed relevance for the study. The journal articles were read through carefully and analyzed based on conceptual aspects and relationship between well-being and performance. 4 Results In table 1 are listed sample of articles used in this literature review. The aim of the study was to clarify the field of well-being and performance. Different concepts in the literature and the use of the same concepts in different ways made the comparison of articles difficult. However, there are signs of the rise of the engagement concept and its effect on performance in the literature. Proponents of this research stream argue that engagement includes all aspects of well-being, cognitive, affective and behavioral, whereas older concepts such as job satisfaction or organizational commitment focus merely on only one of the aspects. It should be noted that the concept of engagement is relatively new and different authors rely on different schools of thought (i.e. engagement is opposite of burnout vs. engagement is more motivational concept). Also there is discussion on whether engagement is a stable state or are there constant fluctuations in the level of engagement. The majority of performance measures used were subjective (self-rating or supervisor/colleague rating), even though some openings were made towards objective measurement (financial returns). In general well-being is seen as a combination of job characteristics (i.e. autonomy, leadership, climate) and personal resources (i.e.motivation, selfefficacy) and performance is created through these. There was four unit and organizational level studies in our sample. Some preliminary results show that especially the lack of wellbeing can have effect on organizational performance. Still, in our sample there were also conflicting results on the relationship of well-being (satisfaction) and profitability. One of our central findings is the variation of the measurement of performance in well-being literature based on our sample. Especially, measurements between individual well-being and organizational performance require more attention. Table 1. Authors, concepts and interpretations for performance and well-being Author(s) Concepts applied/interpretation for performance Concepts applied/interpretation for well being Xanthopoulou,D.,Bakker,A., Demerouti,E., Schaufeli,W Individual performance Financial performance Work engagement 201

198 Bakker,A., Bal,M., 2010 In-role performance Extra role performance Week-level engagement Taris,T Supervisor colleague opinion or Work-engagement State of mind Vigor, dedication, absorption Halbesleben,J., Wheeler,A.2008 In-role performance Negative turnover intention Job embeddedness Work engagement Christian,M. Garza,A. Slaughter,J In-role performance Contextual performance Physical, cognitive and emotional resources. Relatively enduring state of mind. Rich,B., Crawford,E Lepine,J. Job performance Task performance Organizational citizenship Job engagement Physical, cognitive and emotional resources. Motivational concept Janssen,O.,Van 2004 Yperen,J. In-role performance Innovative job performance A mastery orientation A Performance orientation Janssen,O Standard performance Innovative performance job job Fairness perceptions Effort-reward Satisfaction with work and supervisor Seibert,S., Randolph,W.2004 Silver,S., Unit level performance Work unit performance (manager ratings) Individual performance Empowerment climate Psychological empowerment Whitman,D., Van Rooy,D. & Viswesvaran,C Productivity (efficiency, effectiveness) Customer satisfaction Withdrawal Organizational performance level Satisfaction: a work unit s shared internal state that is expressed by affectively and cognitively evaluating shared job experiences with some degree of favor or disfavor. 202

199 Taris,T. Schreurs,P, 2009 Koys, D Client satisfaction Organizational productivity Personnel costs Organizational efficiency Organizational effectiveness Profitability Job satisfaction Emotional exhaustion HR outcomes Employee satisfaction, behaviors and turnover Hakanen,J., Schaufeli,W.,Ahola,K Other Organizational commitment Work engagement Burnout Shaw,J. & Gupta,N Job performance is one factor Well-being Low complaints depression somatic and 5 Discussion Despite the increased research in the job well-being and performance research area, the main concepts are still unsettled in definitions, and hence the variation in definitions and in measurement is huge. For example, Gruman and Saks (2011) argue that consensus is needed in definitions and measures of engagement which is one construct of job well-being. Likewise, the performance measurement seems to be focused more on individual level outcomes rather than organizational level outcomes. At the individual level performance is most commonly viewed as achievement of personal goals in a certain task or a work role and on the other hand as a behavior towards the whole organization. Engagement literature seems to approach well-being and performance from a more holistic point of view. Thus it may be possible that it bridges the gap between practitioner and academic community. There are some openings towards strategic, organizational level. For example recently Macey et al. (2009) argued that it is possible for organizations to gain competitive advantage through employee engagement and they also show supporting findings for an argumentation in different industries: the top 25% on an engagement index had a greater return on assets (ROA), profitability, and greater shareholder value compared to the bottom 25%. Hence, organizational level analysis might help to develop strategic level measures of job well-being outcomes. Still, one should bear in mind the complex nature of organizational performance and further competitive advantage. Longitudinal research is needed in order to capture the possible long term effects of well-being, such as the rate of innovations or the ability to keep and acquire the best talents in the organization. Despite of conceptual problems in the research area, the findings of the earlier research and the present one are promising to continue this research area in future. Reference Available from the authors 203

200 WELLBEING AT WORK CARD TRAINING Mäkinen, P The Centre For Occupational Safety (TTK), Lönnrotinkatu 4 B, FI Helsinki, Finland (TTK is a co-operational organisation administered by Finnish Labour Market Organisations that provides training, information, materials and development services based on the latest knowledge). The Centre for Occupational Safety is introducing a new training program: The Wellbeing at Work Card training. The aim with the training program is to promote processes that support wellbeing at work and cooperation between the different interest groups. The training will focus on the basics, including the different functions and responsibilities of different agents in promoting wellbeing at work. The one-day training program is open to all members of an organisation. Participants receive a Wellbeing at Work Card on completion of the training course. Public trainings and the company specific trainings will start in autumn Keywords: Wellbeing at work, Training, Cooperation, Promote, Process Introduction Based on the studies we know that it pays off to invest in wellbeing. With efficient planning and execution, wellbeing pays for itself and everyone gains. Developing wellbeing at work is increasingly important as the competition for skilled labour grows, as workers age and as productivity demands increase. A satisfied workforce is more motivated and more committed to their job and so more efficient. Wellbeing at work is also important from a general social point of view. A high level of wellbeing at work promotes national health, supports longer working careers and decreases the costs of healthcare and pensions. This paper will introduce the Finnish Wellbeing at Work Card training model. First the background of the process is introduced in this paragraph and then in the following paragraphs there are introduced the training model and the process of building the training is outlined. At the end there are also some comments from the pilot trainings. In tight economy Western Europe countries have to increase the retirement age. The Finnish government, the labour organisations and employer organisations have agreed to aim for an increase in the anticipated retirement age by three years by Two working committees were appointed to draft proposals for extending the working career in general. The Employment Group, consisting of labour unions and employer organisations, agreed in 2010 that Työturvallisuuskeskus (The Centre for Occupational Safety, later referred as TTK) should develop and implement the Wellbeing at Work Card scheme, as part of the projected actions for promoting wellbeing at work. Wellbeing at Work Card Training model 204

201 The Wellbeing at work card training is one-day training. It is open to all members of organisations who are interested in developing wellbeing at their workplace. The aim with the training program is to promote processes that support wellbeing at work and cooperation between the different interest groups. The training will focus on the basics, including the different functions and responsibilities of different agents in promoting wellbeing at work. The training program has a unified content witch is the same in all branches, because the main topics are important in every workplace. The main themes include the different perspectives of wellbeing at work, wellbeing from the managerial and leadership perspective, the code of conduct in the working community as well as health and work ability. The training program includes a pre-assignment and a test that covers the main points of the course. The pre-assignment includes assessing the wellbeing of the participant s own workplace and identifying potential requirements for development. After the training it is recommended to make the assignment again together with the supervisor and the other participants of the workplace. The aim is to prioritize the development needs and to plan the development measures. It is also recommend to list the things that are in good condition at the workplace. Participants receive a Wellbeing at Work Card on completion of the training course and a test. The Centre for Occupational Safety and a number of partners will in future act as training organisations for the program. Public trainings and the company specific trainings will commence in September Methods which were used to built the training The card was developed during autumn 2010 by a working committee included representatives from both labour organisations and TTK. The training model and the training program were adopted by the TTK board on 10 December The specialists of TTK created the training material as slides, pre-assignment and written test. The study results and reports in the wellbeing branch and the results of the developing projects were used in the making the material, for example the results of studies on the connection between a good management and wellbeing at work (1), the positive effect of wellbeing on employees (2, 3) and also the connection between wellbeing at work and productivity (4). The pilot trainings for the program were arranged in April and May 2011 for 18 organisations in different industries. There were 16 company specific trainings and 2 public trainings. In the pilots there were 7 industrial organisations, five municipal organisations, one state organisation and two congregation organisations. Most of the participants were supervisors and Health and Safety managers and representatives. The participants of the pilot performed about 270 Wellbeing at work cards. They were asked for written feedback about the program and the material. 205

202 After the pilot courses TTK s specialist analyzed the feedback and made some changes to the training material. The situations in workplaces, for example what they have already dome to promote wellbeing at work, have to take into account better and more time for discussion should arranged. Results from the pilot trainings Most of the participants in the pilot trainings were satisfied with the training and said that the pilot trainings were successful and the Wellbeing at work card training is very necessary for the workplaces. The following results are gathered from the feedback The training met the expectations - well or completely 84 %, somewhat 15 % The participants got useful information - well or completely 70 %, somewhat 30 % The material supported the handling of the content - well or completely 92 %, somewhat 8 % The school grade was 8,34 (from 4 to 10) The following quotations are from the pilot feedback: The Wellbeing at Work Card training awakened we to draw more attention to the daily satisfaction at work and the management of work-related stress and workload. It was useful to assess yourself the management of wellbeing at work. We will later check if our management group and our steering group of wellbeing and our work safety group think in the same way of our most important development needs. Discussion As the pilot trainings showed there is a real need for training program such as this. Wellbeing at work is best promoted where the work is performed at your own workplace, with management and employees cooperating.the studies also says that Finns are prepared to extend their working careers, provided certain things at work and in their personal lives are in order. Good management, a smoothly operating work community and personal skills as well as personal health and work ability are the central themes of wellbeing at work. These themes are also the main themes in the Wellbeing at Work Card training. The aim of the Wellbeing at Work Card training is to promote processes that support wellbeing at work and cooperation between the different interest groups. TTK has not planned if there is some method to evaluate the benefit of the training for workplaces and to assess if the process had started. The effect of the training is difficult to estimate because it is not easy to point out which development actions due to the training and which actions starts after some other development steps. 206

203 The Wellbeing at Work Card does not expire unlike the other card TTK is managed, the Occupational Safety Card. Despite that TTK recommend that it is useful to renew the training after five years. TTK arrange a many other trainings of different working life development themes. Companies can ask for these trainings if they need more information of some other wellbeing at work themes. References 1) Romana, A., Keskinen, S. & Keskinen, E Oikeudenmukainen johtaminen arjen kokemuksia ja menetelmiä. Kuntien eläkevakuutus. 2) Sinokki, M Social factors at work and the health of employees. 3) Kivimäki et al Sosiaalinen pääoma ja hyvinvointi työelämän muutospaineissa. 4) von Bonsdorff, Monika E Intentions of early retirement and continuing to work among middle-aged and older employees. 5) von Bonsdorff, Monika E et al. Henkilöstön työkyky ja yrityksen menestyminen vuosina The card Finally, there is a picture of the Wellbeing at Work Card. 207

204 208

205 E2: SOCIAL & HEALTH CARE E2.1 Ergonomic patient handling passport - a concrete tool for improving nurses competence in ergonomics Leena Tamminen-Peter E2.2 User-oriented study as a method for assessing the usability of stethoscopes Erja Sormunen E2.3 Development of Ergonomically designed toilet chair for the people of thir age Promila Sharma E2.4 Study of physiological parameters of nurses working in shift pattern Promila Sharma E2.5 Case: The elderly patient's safety in an acute hospital ward Marketta Heinonen 209

206 ERGONOMIC PATIENT HANDLING PASSPORT - A CONCRETE TOOL FOR IMPROVING NURSES' COMPETENCE IN ERGONOMICS Tamminen-Peter, L. 1 and Fagerström, V. 2 1 Ergosolutions BC Oy Ab, Niittykulmantie 84, FI Turku 2 Finnish Institute of Occupational Health The Finnish Institute of Occupational Health introduced the Ergonomic Patient Handling Passport scheme in The aim of the scheme is to define the competencies, skill, and knowledge levels needed to be able to perform patient transfers safely; to ensure compliance with legislative requirements; and to improve both patient safety and the quality of care. Furthermore, through the scheme's exam, nurses can prove their competence. Good Patient Handling improves nurses ability to assess and avoid risks and thus enhances both nurse and patient safety, in turn lowering the physical load of patient-handling, so that work-related musculoskeletal injuries decrease. Key words: patient handling, passport, nurse, competence 1 Introduction In 1990, The Manual Handling Directive was issued on the minimum health and safety requirements for the manual handling of loads that pose a risk of back injury in particular, to ensure that workers are protected against the risks involved in the handling of heavy loads (Council Directive 90/269/EEC). The directive states: Employers must ensure that workers receive proper training and information on how to handle loads correctly and the risks they might be exposed to, particularly if these tasks are not performed correctly". In social and health care work involves many tasks that pose the risk of back injury. Professional competencies in polytechnics require that nurses have a good basic knowledge of rehabilitative nursing and that they can work in an ergonomic way (The Finnish Ministry of Education 2006). The curriculum of nurses' vocational colleges emphasizes the need to observe occupational health and safety (The Finnish National Board of Education 2009). A survey on the patient handling training of nurses revealed wide variations in instruction among schools. The amount of instruction given in patient handling competencies was usually insufficient (Rantsi 2005). The legal requirement to ensure that qualified students are competent to perform their tasks safely was not fulfilled. Nationwide guidelines of quantity and quality instruction in patient handling would help schools and teachers design suitable curriculums. Extended instruction time and the implementation of training in different studying cycles would help students to master the required skills. To improve the quality of education, teachers need to update their knowledge of patient handling ergonomics. Better co-operation between schools and trainee placements is also needed. However, these are difficult goals to achieve. Thus the Ergonomic Passport scheme has been introduced in Finland to respond to these challenges. The scheme is based on evidence-based practice (Hignett 2003, Nelson & Babtiste 2004, Iakovou 2008) in which mechanical assistive equipment such as hoists significantly reduced work-related risk, as a result ensuring a safer and more dignified approach to handling patients. Other technologically advanced aids, such gait belts with handles, and friction-reducing sliding sheets or boards are also included in the scheme. Good patient handling knowledge and skill improves nurses ability to assess and avoid risks, in turn enhancing nurse and patient safety and lowering the physical load of patient handling (Tamminen-Peter 2005, Jäger et. al 2010). Nevertheless, permanent change in working practices is hard to achieve. 210

207 2 Objectives The aim of the Ergonomic Patient Handling Passport scheme is to define the competencies, skills and knowledge levels needed to be able to perform patient transfers safely; to ensure compliance with legislative requirements; and to improve both patient safety and the quality of care. Furthermore, through the scheme's exam, nurses can prove their competence. 3 Methods In , the Finnish Institute of Occupational Health (FIOH), supported by the Ministry of Social Affairs and Health developed the Ergonomic Patient Handling Passport scheme. During these two years, 200 specialists of an interactive communication network of ergonomics participated in the development work and pilot phases. 3.1 Planning the content of the passport The former project Development of evidence-based ergonomic teaching in patient handling at health care polytechnics and colleges (Tamminen-Peter 2007) constituted a good base and provided material (Tamminen-Peter et al. 2007) to start with. A questionnaire was then sent to all 200 members of the network to help make the content of the passport appropriate and relevant. Theoretical matters, laws and exercises were published for online study. FIOH then decided on the content of the essential practical training, the exam criteria, and how to perform the exam. 3.2 Piloting The content was tested in two phases, first by three pilot courses, in an old people s home, in an university hospital and in a nursing college. Teachers, occupational physiotherapists, nurses and administrative persons were invited to join a focus group to discuss the evaluation results. According to their suggestions, a new improved scheme with an e-learning frame was created with the help of a pedagogical e-learning advisor. The new scheme was piloted through three courses for the experienced teachers and physiotherapists altogether over 60 participants in order to receive their comments on the content. Two pilot courses for the passport trainers were also held. 4 Results After the first pilot phase, the focus group improved the aim of the scheme and assessment criteria. Furthermore, theoretical knowledge was increased with e-learning. The second pilot phase resulted in minor content changes and the assessment criteria were made looser. Presently, the Ergonomic Patient Handling Passport scheme consists of the following four parts: 1) E-learning 2) Practical training of evidence-based principals 3) Application of evidence-based practice at the workplace and 4) Repetition and exam (Figure 1). 211

208 Figure 1. Ergonomic Patient Handling Passport learning scheme 4.1 E-learning The online platform comprises the theoretical fundamentals needed for online study: exercises, tests and a discussion forum. Four tasks must be completed in two months, involving: - reading about epidemiology of nurses' back problems and studying different lifting techniques to understand potential risk factors in patient-handling activities and the causes of musculoskeletal disorders. Further study involves the ergonomics of the work environment, the basics of biomechanics, and the analysis of some pictures. - exercises for three weeks to improve body awareness and keeping a diary about one s own body experiences. - becoming acquainted with assistive devices and hoists and analysing the biomechanical principles to apply them in patient-handling. - reading the acts related to patient-handling and discussing cases with the fellow students in order to become familiar with occupational safety responsibilities and obligations. 4.2 Practical training The practical training lasts 16 hours, and can be organized as follows: 2 x 8 hours, 3 x 5.3 hours, or 4 x 4 hours. It consists of the following: 1) Assessment of patient's condition, patient s dependency level, weight, weight bearing ability, cognitive status, and willingness to co-operate. 2) Principles of normal human movement in order to move optimally when involved in patient-handling and to promote the favourable movement patterns and optimal independence of the patient. 3) Assessment and activation of the patient s own resources and moving ability. The students practice verbal and tactile interaction to optimise the patient's own resources and to encourage their independence. 4) Knowledge and skills to apply safe, ergonomic handling principles i.e. stable base, spine in line, and loads close to the body. Students practice how these assisting principles can be applied in various handling situations such as: getting up from a lying or sitting position, turning and moving in bed, in hygiene care, getting up from the floor. 5) The use of assistive products and patient lifts is practiced in different assistive situations. 6) Documentation of patient's condition, chosen method to assist a patient and required aids. 7) Learning to deal with unpredictable occurrences such as patient falls. The training concentrates on developing problem-solving skills. 212

209 4.3 Application phase After practical training, students return to their workplace to deepen their skills by applying the learned methods to their own patients. Teachers and occupational physiotherapists also practice their skills in some care institution for at least a few days. It is recommended that the application phase lasts for one month. 4.4 Exam Before the exam, students have the opportunity to rehearse for a few hours. During the exam, two transfers are performed, one manually and one by a hoist. The activities are filmed and two qualified passport trainers evaluate the transfers. 5 Discussion The Ergonomic Patient Passport training has been standardized and registered. FIOH provides the passport trainers with training. The passport is valid for five years and is intended for all social and health care professionals, students in the social and health care sectors, and all who assist others in moving. To date, over 400 students have now passed the passport exam and 100 have undergone the trainer training, of whom 40 were teachers from different professional education levels and 1/3 occupational physiotherapists. Some teachers have integrated the content of the passport into the compulsory studies of physiotherapists and nursing students, and all the teachers organize updating courses. It is important that ergonomic and safe working practices are acquired already in vocational training, as e.g. Videman et al (1989; 2005) have shown that back symptoms are a common problem among student nurses. If a person has already acquired non-ergonomic practices it is very hard to 'unlearn' them. Employers spend a great deal of money on teaching workers safe manual handling practices, thus it is economically wise to learn good practices from the start. Occupational physiotherapists organize training at their workplaces. This does not necessarily lead to successful changes in the workplace if it is not part of the risk management system of the organization. A systematic review on patient handling found that interventions based solely on technique training had a poor effect on working practices and injury rates (Hignett et al.2003). Health and safety management research in turn shows that a clear line of responsibility and accountability needs to be identified to create a positive environment for change. Thus patient handling training and Ergonomic Passport training should be part of the risk management system of an organization (Tamminen-Peter et al. 2010). Time will show if with this approach achieves working practice changes in manual handling and decreases musculoskeletal symptoms. Nevertheless, the first results of Henriksson s (2011) evaluation study are promising. 6 References EC Manual Handling Directive The manual handling directive (90/269/EEC). Henriksson, A Potilassiirtojen Ergonomiakortti -koulutuksen vaikutukset potilaan siirtymisen avustamiseen hoitajien kokemana. ([in English :The effects of the Ergonomic Patient Handling Card Training on assisting a patient transfer experiences of nurses.]. Masters` graduate thesis, University of Eastern Finland. Hignett, S. Crumpton, E. Ruszala, S. Alexander, P. Fray, M. & Fletcher, B Evidence-Based Patient Handling. Task, equipment and interventions. London: Routledge. Iakovou, G.T Implementation of an evidence-based safe patients handling and movement mobility curriculum in an associate degree nursing program. Teaching and Learning in Nursing 3, Jäger, M. Jordan, C. Theilmeier, A. Luttmann, A. & the DOLLY Group Lumbar-load quantification and overload-risk prevention for manual patient handling - The Dortmund Approach. 213

210 In: R. Mondelo, P., Karwowski, W., Saarela, K., Hale, A.; Occhipinti, E. (eds) Proc 8th Int Conf Occup Risk Prevention ORP2010, CD-Rom (9 pp.), Valencia Nelson, A. & Baptiste, A Evidence-based practices for safe patient handling and movement. Online Journal of Issues in Nursing. Rantsi, H Potilaan liikkumisen avustus- ja siirtomenetelmien opetus sosiaali- ja terveysalan oppilaitoksissa. Sosiaali- ja terveysministeriön selvityksiä 2005:26. Helsinki: sosiaali- ja terveysministeriö. Tamminen-Peter, L. Moilanen, A. & Fagerström V A Management Model for Physical Risks in the Care Work. Finnish Institute of Occupational Health, Tampere: Juvenes Print. Tamminen-Peter, L Ergonomiaopetuksen kehittäminen sosiaali- ja terveydenhoitoalan oppilaitoksissa. Loppuraportti. Sosiaali- ja terveysministeriön selvityksiä 2007:22. Tamminen-Peter, L. Eloranta, M.-B. Kivivirta, M.-L. Mämmelä, E. Salokoski, I. & Ylikangas, A Potilaan siirtymisen ergonominen avustaminen. [in English: How ergonomically assist a patient to move.] A teacher's manual and DVD Sosiaali- ja terveysministeriö, Helsinki. Tamminen-Peter, L Hoitajan fyysinen kuormittuminen potilaan siirtymisen avustamisessa kolmen siirtomenetelmän vertailu. Turku: Turun Yliopisto. Videman T, Rauhala H, Asp S, Lindström K, Cedercreutz G, Kamppi M. Tola, S & Troup, J.D.G.. Patient handling skill, back injuries and back pain: an intervention study in nursing. Spine. 1989;14(2): Videman T, Ojajärvi A, Riihimäki H. & Troup J.D.G Low Back Pain Among Nurses. A Follow-up Beginning at entry to the Nursing School. Spine 30 (20),

211 USER-ORIENTED STUDY AS A METHOD FOR ASSESSING THE USABILITY OF STETHOSCOPES Sormunen, E and Jussila, K Finnish Institute of Occupational Health, FI Oulu, Finland Seven experienced physicians in pre-hospital care evaluated the usability features of two types of stethoscopes, one acoustic and the other electrical, during a simulated work task. In the overall evaluation of usability, the acoustic stethoscope was perceived as better than the electrical one (p<0.05). However, 60% of the physicians preferred the electrical stethoscope, because of its capability to auscultate through layers of clothing, therefore being the best stethoscope for examining patients in, for example, disaster situations in cold environments. The results of this user-oriented evaluation study can be used for both product development and the acquisition of stethoscopes. Keywords: Usability, User, Visual Analogue Scale (VAS), System Usability Scale (SUS), Stethoscope 1 Introduction Pre-hospital care includes basic treatment for as many as possible and as fast as possible (Jama 2007). To achieve the best possible care for patients, the medical equipment used must also be reliable and easy to operate. The stethoscope is one of the most basic instruments used by physicians in the initial diagnosis of respiratory conditions (Callahan et al. 2007). During auscultation, the chest of the patient has conventionally been uncovered in order to check the chest and diaphragm movements and synchronisms, and also to verify possible chest injuries (Jama 2007). If circumstances do not allow the removal of clothing (e.g. in order to prevent body cooling in a disaster situation in extreme cold conditions) the alternative is to use an electrical stethoscope that is capable of operating through layers of clothing. Usability can be defined as the extent to which a product can be applied by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use (SFS-EN ). In this context, effectiveness can be defined as the degree of success in dealing with a product. Efficiency means the time needed to carry out a task with the product; meanwhile satisfaction refers to a positive attitude towards the use of the product (Jokela 2010). The best possible match between the product and its users can be achieved by evaluating the product within an authentic or simulated operating situation among real users (Pheasant 1996). 2 Objective The aim of this study was to compare the usability features of two types of stethoscopes, one acoustic and the other electrical, during a simulated work task (Figure 1). This study is part of the CoSafe project, the Cooperation for Safety in Sparsely Populated Areas (www.cosafe.eu). In the project, the aim was to produce information and increase knowledge of new products, services and procedures related to rescue operations in cold climate conditions. 215

212 Figure 1. During the simulation task, auscultation with the electrical stethoscope was performed through three layered winter clothing. 3 Materials and methods 3.1 Study population Seven male physicians in pre-hospital care in the Oulu region of Finland volunteered as test subjects for the study. The mean of their work experience was 16 years (standard deviation 9 years). 3.2 Procedure Measurements were carried out under undisturbed indoor conditions with the ambient temperature varying between 24 and 26ºC. The task was to auscultate the respiratory tones of a healthy subject. With the acoustic stethoscope (Figure 2A), auscultation was carried out only on the skin (i.e. under the subject's clothes). Auscultation with the electrical stethoscope (Figure 2B) was carried out in three additional situations: through a base layer garment (rib knit), a mid-layer garment (terry knit), and an outer shell garment (quilted jacket). The testers were told to imagine that the treatment situation was taking place in an accident situation in extremely cold conditions. The tested electrical stethoscope was designed to have the capability to operate through layers of clothing without the need to undress the accident or injured victim (Figure 2). In order to adjust to the tested stethoscopes, the testers were allowed to use the stethoscopes before the measurements began. Each situation was set as the first in one of the trials, in which the other situations were set in random order. A) B) Figure 2. The acoustic (A) and electrical (B) stethoscopes used in the usability study Measurements After the auscultation task, visual analogue scales (VAS) were used to analyse certain usability features of the stethoscopes, such as readiness for auscultation, placement of the headphones, fit for the hand, ability to eliminate ambient-noise, auscultation reliability, storage after auscultation, and cleanability, as well as in making an overall evaluation. Additional usability features of the electrical stethoscope were also analysed, such as the fastening of the headphone cable, the location 216

213 of the filter switch, the operation of the filter switch, the operation of the volume switch, and the significance of the data recording. The testers rated the perceived features on a VAS with a range of 0 to 100 millimetres (0 = very poor to 100 = very good) (Price et al. 1983). The global view of systems usability with respect to the electrical stethoscope was evaluated with the use of the System Usability Scale (SUS). The statements covered the following aspects of system usability: training, complexity, and need for support. System usability was presented as the theoretical percentage of "perfection"; with a range of 0 to 100. The SUS questionnaire is regarded as a valid tool for usability assessment (Brooke 1986). Since the acoustic stethoscope is a commonly used device for auscultations among physicians in pre-hospital care, the SUS questionnaire was not used for it. Furthermore, the testers were asked which test situation they would choose as the best, second best, and third best for auscultation in a disaster situation (Lintula and Nevala 2006). All of the free comments about the usability of the stethoscopes were taken into consideration. The data are presented as mean values with standard errors. The results were analysed using Microsoft Office Excel The differences between the stethoscopes were tested using a paired sampled t-test. The differences were considered statistically significant if p < Results Certain features of the usability of both the electrical and acoustic stethoscopes are presented in Table 1. There were no differences between the tested stethoscopes according to the placement of the headphones, fit for the hand, and cleanability, whereas the readiness for auscultation, storage after auscultation, and the overall evaluation were assessed as better for the acoustic stethoscope than for the electrical stethoscope (p<0.05). There were no significant differences regarding the reliability of auscultation between the electrical and acoustic stethoscopes when the auscultation was performed under the clothes. However, the number of layers of clothing worn impaired the reliability of the auscultation with the electrical stethoscope when compared with that of the acoustic stethoscope on the skin (p<0.05). Similarly, the ability to eliminate ambient-noise became weaker when the auscultation with the electrical stethoscope was performed through layers of clothing. 217

214 Table 1. Mean values with standard errors of perceived usability (visual analogue scale, from 0 = "very poor" to 100 = "very good") for the features of the electrical and acoustic stethoscopes as rated by the physicians (n=7) after the auscultation task. Usability feature Electrical stethoscope Acoustic stethoscope Statistical significance (paired sample t-test) Readiness for auscultation 65±6 76±5 p<0.05 Placement of the headphones 79±4 81±4 ns Fit for hand 75±4 81±4 ns Ability to eliminate ambient-noise o under the clothes (skin) 47±7 71±9 p<0.05 o on the shirt 50±10 ns o on the fleece 44±10 p<0.05 o on the quilted jacket 43±10 ns Auscultation reliability o under the clothes (skin) 68±5 75±8 ns o on the shirt 64±7 p<0.05 o on the fleece 57±7 p<0.01 o on the quilted jacket 37±9 a p<0.05 Storage after auscultation 30±6 79±6 p<0.001 Cleanability 62±7 69±5 ns Overall evaluation 47±7 75±6 p<0.05 a p<0.05 compared with auscultation under the clothes with the same stethoscope, ns = not significant Of the testers, 60% considered the electrical stethoscope to be the best tool for auscultation in a fictional disaster in extremely cold conditions. The acoustic stethoscope was chosen as the best model by three testers (40%), whereas the electrical stethoscope was assessed as superior by four testers with respect to the following placement: o through outer shell garment by two testers o through base layer garment by one tester o under the clothes (skin) by one tester (Figure 3). Electrical stethoscope On the skin Through base layer garment Through outer shell garment Acoustic stethoscope Subjects Figure 3. The order of superiority according to the best stethoscope for use in a fictional disaster in extreme cold conditions (n = 7). The SUS score for auscultation with the electrical stethoscope was 63. The testers provided important comments about the key usability features of a stethoscope used in disaster situations: easy storage, quickly ready for use, a good fit for the hand, easy to disinfect, ability to eliminate 218

215 noise, and reliable auscultation result. Some features of the electrical stethoscope were questioned, for example, the long length of the headphone cable and some technical features in rainy and cold conditions. 5 Discussion and conclusions The study showed differences in the usability features of a traditional acoustic stethoscope and an electrical stethoscope. As measured by VAS scores, the acoustic stethoscope was considered the best in the overall evaluation of the usability features. Although the electrical stethoscope allowed auscultation through clothing, the reliability of its auscultation and its ability to eliminate noise (i.e. the effectiveness component of the usability concept) were regarded as weaker than with the acoustic stethoscope. On the contrary, in the study of Tourtier et al. (2011) the electronic stethoscope was considered better than the acoustic model for reducing ambient-noise and amplifying heart and lung sounds. In our study, it is possible that the lack of experience in using the electrical stethoscope affected the interpretation of the auscultation. In the future, it would be interesting to compare, for example, different electrical models (Callahan et al. 2007). However, and interestingly, even though the acoustic stethoscope received the best overall evaluation, over half of the testers preferred the electrical stethoscope in disaster situations in extremely cold conditions. It can be assumed that the possibility to proceed without the need to undress accident or injured patients was regarded as a good innovation, especially when maintaining the patient s body temperature is critical. Technical proposals for improvements in the electrical stethoscope, such as wireless operation between the headphones and chest piece, were important information gained for product development. This study took place indoors, at a room temperature of 24ºC. We were not therefore able to test auscultation under, for example, rainy and cold conditions that might have affected the results. However, the testers were experienced physicians in pre-hospital care, and therefore, the simulation situation can be considered acceptable for this product usability assessment. In evaluations of product usability in general, it is essential to take into consideration all aspects in the concept of usability (effectiveness, efficiency and satisfaction) in authentic contexts of use. In addition, finding the right measures and defining the usability goals make the field of usability study interesting and demanding. 6 Acknowledgements This study was carried out as part of the project "Cooperation for Safety in Sparsely Populated Areas, CoSafe" (www.cosafe.eu), which was financially supported by the European Union, the Northern Periphery Programme, and the Ministry of Employment and the Economy of Finland, for which the authors wish to express their thanks. 219

216 7 References Brooke, J SUS A "quick and dirty" usability scale, Digital Equipment Co, Ltd. United Kingdom Callahan, D., Waugh, J., Mathew, G. & Granger, M.W Stethoscopes: what are we hearing? Biomedical Instrumentation & Technology, 41, 4, Jama, T Potilashoidon periaatteet. [Principles for pre-hospital care]. In Castrén, M., Ekman, S., Martikainen, M., Sahi, T. & Söder, J. Suuronnettomuusopas. [A guidebook for rescue operations in a disaster]. Helsinki, Finland: Duodecim. Jokela, T Navigoi oikein käytettävyyden vesillä. Opas käytettävyysohjattuun vuorovaikutussuunnitteluun. [Navigate correctly in the field of usability. A guidebook for the usabilitycontrolled design of interaction]. Rovaniemi, Finland: Väylä-Yhtiöt Oy. Lintula, M. & Nevala, N Ergonomics and the usability of mechanical single-channel liquid dosage pipettes. International Journal of Industrial Ergonomics, 36, Pheasant, S.T Bodyspace: anthropometry, ergonomics and the design of work. 2 nd ed. London: Taylor & Francis. Price, D., McGrath, P.A., Rafii, A. & Buckinham, B The validation of visual analogue scale as ratio scale measure for chronic and experimental pain. Pain, 17, SFS-EN Ergonomic requirements for office work with visual display terminals (VDTs). Part 11: Guidance on usability. Helsinki: Finnish Standards Association SFS. Tourtier, J.P., Libert, N., Clapson, P., Tazaroute, K., Borne, M., Grasser, L, Debien, B & Auroy, Y Auscultation in flight: Comparison of conventional and electronic stethoscopes. Air Medical Journal, 30, 3,

217 ERGONOMIC TOILET CHAIR FOR SAFETY AND WELLBEING OF OLD AGE PEOPLE Dr. Nirmal Kaur* & Dr. Promila Sharma** *SRF & ** Professor Dept of Family Resource Management, College of Home Science, G.B.P.U.A. & T., Pantnagar, Uttarakhand India, Abstract In the study of Hirvensalo et al. (2000) it has been focused that aging is associated with increasing difficulty in getting around on foot, both indoors and outdoors. One definition of impaired mobility is the inability to walk a specified distance, to stand and climb stairs without assistance and to cross a street controlled by traffic lights in the time allotted. It is important that in the future, the needs of older people are taken into account in the design of products and services and the improvements in housing conditions (toilets, bathroom, Kitchen etc.) and neighborhood quality in order to facilitate the involvement of older adults in social and physical activities in their homes and neighborhoods. Keeping in mind the study was planned to recommend an ergonomically designed toilet chair for old age people for their wellbeing as the cases of accidents were found more while using Indian toilet with the following objectives 1) To study the clinical history of the old age people.2) To study the occurrences of accidents among old age people. and 3)Recommendation and validation of ergonomic toilet chair for safety and wellbeing of old age people. The study was conducted in U.S.Nagar district of Uttarakhand state. 200 people were selected purposively of the age group of years. With the help of interview schedule their clinical history and occurrence of accidents were reported and an ergonomically designed chair was recommended for their wellbeing and the satisfaction level was also taken with the help of checklist. Results showed that 41 per cent and 62 per cent males and females respectively were having joint problem due to that they were having problem in walking (39% male & 42 % female). Due to all these they felt severe problem in using Indian toilet and all the accidents prevailing among them were due to the use of Indian toilet. When an ergonomically designed toilet chair was recommended and was used by the respondents for one week 60 per cent respondents that they were highly satisfied by its use. INTRODUCTION It is well known that the world s population is ageing, with more developed regions leading the process, because of increasing survival to older ages as well as smaller numbers of births (United Nations Population Division, 1998 revision). Consequently, the support of this ever expanding elderly population has become of increasing concern. Now a day s the knee problem is very common among third age people who creates hindrance in using Indian toilet seat because of their problem to sit down on the feet and folding their knees. It has been seen that the total number of accidents in the home takes place with the highest occurrences in the toilets, bathroom, kitchens and stairs. Thus, this age group should not be ignored in any ways and should be encouraged by the society and also helped in all ways so that they can live or survive easily inspite of having disabilities among them. That is why the study was planned with the following objectives; 1. To study the clinical history of the old age people. 2. To study the occurrences of accidents among old age people. 221

218 3. Recommendation and validation of ergonomic toilet chair for safety and wellbeing of old age people. METHODOLOGY The present study was conducted in two regions of Uttarakhand state i.e. Pantnagar and Rudrapur block of Udham Singh Nagar district. The whole list of families of Pantnagar and Rudrapur block was made who have old age people than out of that list the families were chosen randomly until the total sample size of 100 people each from both the blocks were selected. Now there were 100 old age people from each blocks out of which 50% were male and 50% were female selected thus altogether making total size of 200 people of old age. Descriptive data was collected with the help of Interview schedule regarding clinical history and occurrences of accidents. Then the ergonomic toilet chair was given to the controlled group (20% people of old age) for one week and on the basis of satisfaction scale the satisfaction score was calculated. RESULTS And DISCUSSION Clinical history of the respondents According to a Yale University Study, the rate of falls among people aged 65 or older is about 30%; among patients aged 80 or older, the rate is 50% (Gill et al., 2000), of the elderly who do fall, about 10% sustain a serious injury such as a fracture, joint dislocation or severe head injury. Falls of fall related injuries are also associated with joint pain. Table 1 envisaged that 41 per cent of males and 62 per cent of females were having joint problem. It can also be seen from the table, that most of males as well as females developed this problem after 50 years of age whereas, it can also be seen that, some of the females, (i.e. 8 per cent) reported this problem in their early life, i.e. at around 30 years of age and male also reported at around 40 years of age. Due to joints problem the males, (i.e. 39 per cent) felt pain during walking whereas 42 per cent females felt pain all the time. The reason may be that, they were having this problem for more than 2 years whereas; only 20 per cent males were having the pain for more than 2 years.efforts were made to discover the cause of problems and it was found that among the males the reason of their problem was fracture, (i.e. 18 per cent) whereas, among females the common reason was slip, (i.e. 33 per cent). It was tried to find out the problems in using Indian Toilet and it was found that both the sexes were having pain in their joints and 28 and 14 per cent males and 32 and 21 per cent females had numbness in their feet and calf muscles, respectively. All the problematic males and females had problem in standing after sitting from Indian toilet. 222

219 When respondents were asked about the treatment they were taking for cure of their problem then only 8 per cent males and 12 per cent females reported that they took medicines whereas, 33 per cent males expressed that they tried to avoid the strain and many females, 25 per cent go for physiotherapy and 4 per cent did exercise/yoga and 21 per cent females were did nothing to cure their problem. When people were asked about how they felt after treatment they reported that only 18 per cent males and 8 per cent females gave positive response for it and there were 4 per cent males and 2 per cent females who felt better with treatment. Among females there were 20 per cent females who felt better with physiotherapy and only 5 per cent were better after physiotherapy. Assessment of occurrences of accidents among the respondents in the Indian toilet Older persons, whose bones are often less dense and more brittle, are especially vulnerable to serious injuries from home accidents. Elderly people living independently without any assistance should consider all improved safety measures within their homes, as elderly people are more prone to serious injuries and long term disability if they fall. In the general population, it is estimated that one third of community dwelling adults aged 65 years or older fall each year (Mc Elbinney et al., 1998). Home injuries occur as a result of falls, slips and most of these accidents are considered preventable. Table 2 revealed age and sex wise distribution of total number of accidents among the people of third age. It was found that most of the falls and accidents were due to the use of Indian toilet. Accidents were found more in case of females rather than males of old age, which results in injuries. It can be seen in the table-2 that these were increasing with the increase in the age Validation of ergonomically designed toilet chair Extent of satisfaction derived by the old age people of third age was calculated on the controlled group of 20 per cent people of third age. In order to get meaningful results, a checklist on satisfaction statements was constructed to assess the extent of satisfaction derived. Responses on each statement in the checklist were scored for highly satisfied (3), satisfied (2) and not satisfied (1). From the individual item score total and mean scores on each statement of third age people were computed. The findings related to frequency distribution, total and mean scores on each statement of the scale were presented in table 3.With the height of the toilet chair, 70 per cent people were highly satisfied whereas, only 30 per cent people were only satisfied. Total score obtained was 54 and mean score was 2.7.In case of weight of toilet chair, majority of the people (i.e. 60 per cent) were satisfied, whereas, 25 and 15 per cent reported not satisfied and highly satisfied, respectively. In this case total score was found 38 and mean score was

220 In case of width and depth of the toilet chair, there were 75 per cent people of third age, who were highly satisfied and only 25 per cent reported satisfied. The total score and mean score were found 55 and 2.75, respectively.when the score for height of hand rest was calculated then it was found that cent per cent people of third age were highly satisfied. Total score was calculated 60 with the mean score of 3. There were 65 per cent people who reported highly satisfied for supporting handle whereas, 35 per cent reported satisfied. Total and mean scores obtained were 53 and 2.65, respectively.with the operation of assembling 65 percent people were satisfied, and 25 and 10 per cent were highly satisfied and not satisfied, respectively. Here the total score was calculated as 43 and mean scores was Removal of pan was found satisfactory by 60 per cent people and 25 per cent found it highly satisfactory whereas, only 15 per cent were there who were not satisfied at all. Total score and mean scores were 42 and 2.1, respectively. When the respondents were asked about whether they were able to carry the chair themselves, then there were only 15 per cent people who were highly satisfied and 45 per cent people were satisfied by it. There were 40 per cent people who were not able to carry the toilet chair by themselves. Here the total score was found 35 and mean score was Most of the people i.e. 75 per cent were highly satisfied by the material of the toilet chair and there were 25 per cent people who were only satisfied by it the total and mean score was obtained as 55 and 2.75.Material of seat plate was found satisfactory by most of the people (i.e. 55 per cent) and 20 per cent people reported that, they were highly satisfied and there were 25 per cent people, who were not satisfied at all. The total calculated value was 39 with the mean score of For material of back rest 75 per cent people reported satisfied and rest 25 percent reported highly satisfied, with the total score of 45 and mean score 2.25.In case of material of handle and comfortableness, 70 per cent people reported highly satisfied and rest 30 per cent found it satisfied only. The total score and mean score was found 54 and 2.7, respectively. There were 50 per cent people who were satisfied with the cost of the chair and 25 per cent respondents were highly satisfied but there were 25 per cent people who were not satisfied with the cost at all. Total score was calculated as 40 and mean score was calculated 2. The score earned by third age people was categorized in the ranges i.e. 0-15, 15, 30 and scores and interpreted as low, moderate and high level of satisfaction, respectively. Table 4 illustrated that 60 per cent people of third age were found to be in high level range, while 30 per cent in moderate range of satisfaction level. There were 10 per cent people who were in the range of low level of satisfaction. 224

221 CONCLUSION It is the duty of every person to take care of the basic needs of their elders especially old ones because it is the age of limitations and disabilities in doing the work by their own. Hence the study was planned to help the old age people for their wellbeing as the use of Indian toilet was found difficult by them which was associated with injuries falls and slips. Thus the use of ergonomic toilet chair was recommended for them and they were found highly satisfied by using it. REFERENCES 1. Gill, T.M.; Williams, C.S. and Tinetti, M.E. (2000). Environmental hazards and the risk of nonsyncopal falls in the homes of community living older persons. Med. Care, 38 (12): Hirvensalo, M.; Rantanen, T. and Heikkinen, E. (2000). Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community living older population. J. Am. Geriatr. Soc., 48 (5): McElbinney, J.; Koval, K.J. and Zucherman, J.D. (1998). Falls in the elderly, Archives of the American academy of orthopedic Surgeons. 2 (1): United Nations Population Division (1999). World population projects. The 1998 Revision. United Nations, New York. Table 1: Clinical History of the respondents Criteria Male F=100 Female F=100 Total F= Having joint problem 41 (41) 62 (62) 103 (51.5) 2. Able to sit in squatting posture 59 (59) 38 (38) 97 (48.5) 3. Problem in using Indian toilet 41 (41) 62 (62) 103 (51.5) 4. Type of problem in using Indian toilet Pain in knee joints 41 (41) 62 (62) 103 (51.5) Numbness in feet 28 (28) 32 (32) 60 (30) Numbness in calf muscles 14 (14) 21 (21) 35 (18.5) Standing after sitting 41 (41) 62 (62) 103 (51.5) 5. Time period of having problem a. Last 6 months 12 months b. Last 12 months 18 months 8 (8) 6 (6) 14 (7) c. Last 18 months 24 months 13 (13) 16 (16) 29 (14.5) d. More than 24 months 20 (20) 40 (40) 60 (30) 6. When feel pain a. During standing 2 (2) 18 (18) 20 (10) b. During sitting c. During walking 39 (39) 2 (2) 41 (20.5) d. All the time - 42 (42) 42 (21) 7. How problem occur a. After fall 4 (4) 5 (5) 9 (4.5) b. After slip 6 (6) 33 (33) 39 (19.5) 225

222 c. After accident 13 (13) 4 (4) 17 (8.5) d. After fracture 18 (18) 20 (20) 38 (19) 8. Age when problem starts a. Before 30 years b (8) 8 (4) c (9) 10 (10) 19 (9.5) d (32) 44 (44) 76 (38) 9. Treatment taking for cure a. Medicine 8 (8) 12 (12) 20 (10) b. Physiotherapy - 25 (25) 25 (12.5) c. Exercise/Yoga - 4 (4) 4 (2) d. Avoidance of strain 33 (33) - 33 (16.5) 10. Felt betterment a. Better with treatment 4 (4) 2 (2) 6 (3) b. Better after treatment 18 (18) 8 (8) 26 (13) c. Better with physiotherapy - 20 (20) 20 (10) d. Better after physiotherapy - 5 (5) 5 (2.5) Figures in parenthesis represent percentage Table 2: Age and sex wise occurrence of accidents Criteria 60-65yrs 65-70yrs total Chi-square values M F M F M F 15 (15) 18 (18) 26 (26) 44 (44) 41 (20.5) 62 (31) NS 1.Fall due to standing after sitting 2.Fall due to no 10 (10) 19 (19) 25 (25) 30 (30) 35 (17.5) support (24.5) NS 3.Fall due to 4 (4) 7 (7) 8 (8) 11 (11) 12 (6) 18 (9) slippery ness NS Total Figures in parenthesis represent percentage M=Male, F=Female, NS=Non Significant Table 3: Extent of satisfaction derived by third age people about ergonomically designed toilet chair Description Highly satisfied = 3 Satisfied = 2 Not satisfied = 1 Total score Mean score 1. Height of chair 14 (70) 6 (30) Weight of chair 3 (15) 12 (60) 5 (25) Width of chair 15 (75) 5 (25) Depth of chair 15 (75) 5 (25) Height of hand rest 20 (100) Supporting handle 13 (65) 7 (35) Operation of assembling 5 (25) 13 (65) 2 (10) Removal of pan 5 (25) 12 (60) 3 (15) Able to carry chair 3 (15) 9 (45) 8 (40) Material of toilet chair 15 (75) 5 (25)

223 11. Material of seat plate 4 (20) 11 (55) 5 (25) Material of back rest 5 (25) 15 (75) Material of hand rest 14 (70) 6 (30) Comfortableness 14 (70) 6 (30) Cost of chair 5 (25) 10 (50) 5 (25) Figures in parentheses represent percentage Table 4: Distribution of third age people by their scores on extent of satisfaction derived Score Range Third age people 0-15 Low 2 (10) Moderate 6 (30) High 12 (60) 227

224 STUDY OF PHYSIOLOGICAL PARAMETERS OF NURSES WORKING IN SHIFT PATTERN Dr. Indu karki*, Scientist, Dr. Promila Sharma**, Professor, Dr. S. K. Rastogi, Professor*** *Central Institute of Post harvest engineering and Technology, Ludhiana, Punjab, India **Department of Resource Management, G.B.Pant Univ. of Agri. & Tech., Pantnagar, India ***Department of Physiology, College of Veterinary Science, G.B.Pant Univ. of Agri. & Tech., Pantnagar, India Stress is affecting nurses all over world for long time. Nurses' environment includes an enclosed atmosphere, time pressures, excessive noise, undue quiet, long working hours. Usually nurses are not trained to cope up with these factors but chronic stress results in adverse ill effects when there are additional stress factors also which may be the home stress, conflict at work, inadequate staffing, poor performance and poor facilities at workplace. Objectives: Present investigation was planned to findout physiological cost of work of nurses in terms of blood pressure, pulse rate (per min), heart rate, energy expenditure rate of nurses engaged in different group of activities. Method: Descriptive-cum-experimental research design was selected. Purposive-cum-random sampling technique was used to select study area, samples. Uttarakhand state was selected purposively as investigator belonged to it. Districts like Udham Singh Nagar, Nainital were selected purposively from state. Five government, 6 private hospitals were chosen randomly from these blocks, total of 120 ward nurses were selected. Out of these nurses, 12 nurses were selected randomly for experimental group. Instruments as blood pressure monitor, heart rate monitor were used for experiments. Interview schedule and checklist were used data collection. Results: In group I activities (give medicine,injection, dripping, weight checkup, resting mean blood pressure (B.P mmhg) was which increased to (during activity) with change in pulse rate from 78 to For group I activity, mean heart rate at resting level was beats/minute, which increased up to beats/min during performance. Whereas, per cent increase in Heart rate was 5.57, which was minimum in case of group I activity. While performing activities like giving medicine, dripping, giving injection, weight check-up (Group I activity), Energy expenditure rate before work was 3.40 kj/min which increased to 9.23 kj/min (during work), with per cent increase of 20. Conclusions: on basis of energy expenditure, group III activities (mobility of patients, first aid and emergency and measure blood pressure) were found to be most strenuous activity, however, group I activity (giving medicine, dripping, give injection,weight checkup) were least exhaustive one. mobility of patients, first aid, emergency, measuring blood pressure involve use of muscles of the nurses for a long time and that too in awkward position which results in awkward posture. 228

225 CASE: THE ELDERLY PATIENT S SAFETY IN AN ACUTE HOSPITAL WARD Heinonen, Marketta Oulun yliopistollinen sairaala (OYS) PL 21 Operatiivinen tulosalue, vuodeosasto OYS Abstract This paper presents an ongoing safety project in an acute ward in Oulu University Hospital. The aim of the safety project is to prevent accidents of elderly patients during their stay in a ward before and after surgery. Falls are health events that cause discomfort for older adults and stress for nurses. Main methods of the safety project are observations in hospital, literature and HaiPro -reports. The purpose of the study is to discuss what can be done in an acute ward for better safety of elderly patient. Key words: ability HaiPro, elderly patient, prevention of falling, delirium, balance 1. Introduction The aim of this paper is to present the safety project, which is ongoing in Oulu University hospital in surgery ward 3. The ward has 26 beds. There are treated for example lung and heart surgery patients. Nursing staff in the ward have systematically made HaiPro reports when accidents have happened (adverse events) or when accidents have almost happened to the patients (near misses). Reports have been made since January Those so-called HaiPro reports suggested that specifically elderly patients might have a risk of an accident during hospital stay. In the spring of 2010 chief surgeon Martti Lepojärvi founded safety project, which task is to find solutions to prevent falls. Today, both middle-aged and elderly patients are treated in the ward. In the future, there can be mostly elderly patients. Amount of aged people in population is growing and it means that also number of elderly patients is growing in health care. When a person is 65-year-old, he need health care services, more than earlier and many over 80-year-old persons need long-term health care (Nivalainen & Sulamaa 2005, 114). The nurses have noted while working that attention should be paid specifically to the safety of the elderly patients. This paper is focusing to the elderly patients safety in the acute ward. 229

226 1.1 Objectives and methods The safety project is asking how to prevent elderly patients falls in a hospital ward. The aim is to improve elderly patients' safety during hospitalization. So far, methods have been review to the HaiPro reports, literature and observations. Group members have first observed what kind safety problems in the ward appear and next they have discussed possible solutions to improve safety in the ward. 2. Background HaiPro reporting system has focused attention to the safety problems. HaiPro system is one of reasons why safety of patients has raised subject of debate. HaiPro is a web-based tool for reporting patient safety incidents. It has been used three years in health care organizations. Organisations have received HaiPro reports at the end of December (Hankonen 2011, 9; Wallenius 2010) The reasons for collecting the HaiPro reports are to get information on near misses and adverse events, save the information, to process and analysis of events further, to learn from the events and to develop activities. Writer of the report describes what kind of adverse events was. He describes what the consequences of the hazardous event were to the patient's wellbeing, to the health care unit, and to other potential parties. Writer think about, why the hazardous event happened and how it could be avoided in future. (Voipio- Pulkki, Inkinen, Tammela et al. 2009, 14-15). The good safety culture, which means blame-free reporting and open discussion about the conditions, makes it possible to the safety group to work for safer ward. There are associations, guidelines and research, which deal with safety. For example Saarnio's study showed that use of physical restraints on the elderly was common in institutional care. One of the purposes to limit the mobility of the elderly was to prevent old persons from accidents. (Saarnio 2009, 3, 78). Patient Safety Association was founded in February The association's aim is to promote patient safety and patient safety research. (Wallenius 2010). May 2011 came the force of the new healthcare law. The law orders, that health care unit must make a quality management and patient safety plan. (Koskela 2011). Finland s strategy for the patient safety for the years says that safety includes those principles and functions of individuals and organisations, whose purpose is to secure the safety of the nursing and to protect the patient from being damaged. Safety means that patient gets the needed and right treatment, which causes so little adverse effects as possible. The safety contains the quality of the nursing, medication safety and device safety. (Sosiaali- ja terveysministeriö 2009, 20) Hospital patient falls can be due to a combination of patient-related (intrinsic) and environmental factors. Interventions can be dividing to the patient modification and to the environment modification. If research can not give evidences that different layouts, flooring, lighting and technology can reduce risk of falls, very expensive environmental renovation construction will not be done. (Sands, Hignett, Youde et al. 2010) People grow old individually. In general old age is being considered to begin at the age of years. Some of the diseases are more common in aged population. These diseases are memory disease, cardiovascular disease, diabetes, osteoporosis and osteoarthritis, and certain malignant tumours such as prostate cancer for men. (Heikkinen 2002, 17-18). Risk factors for falls are elderly person's weakened 230

227 balance and muscle activity as well as many illnesses and medications. Other risk factors are previous falls and the fear of a new fall, weakened senses, use of walker aid, age more than 80 years and the lack of physical movement. Old age alone does not increase the risk of falling, but affecting factors are everyone's own physically aging changes and possible diseases. Age modifies the body such a way that it is sensitive to drug side effects. Elderly patient s medication can cause sleepiness, slower reflexes, blurred vision, low blood pressure and orthostatic hypotension. If an elderly uses simultaneously several drugs, it increases the risk of falls. (Mänty, Sihvonen, Hulkko et al. 2007, 11, 16) On the other hand Iinattiniemi (2009, 65) says, that feelings of anxiety, nervousness or fear may be more significant risk factors for fall than the drugs used to treat. Feelings of anxiety and fear are one of those reasons, which can lead to the delirium. Delirium is an acute deterioration of brain function. Typical to the delirium are disturbed attention with a failure to concentrate, visual hallucinations, disorientation, an abnormal sleep pattern with daily sleepiness and night time agitation, anger, fear, apathy. Delirium appears often after surgery. Risk factors to the delirium are older age, stroke, oxygen deprivation, inflammation, physiologic stress, dementia, depression, poor general health, alcoholism, pain medication and some sleeping pills. (Katznelson, 2010) 3. Research methods In safety project group are two nurses and one doctor. In addition, head nurse and surgeon doctor participate to the project. This far most important data have been participants own observations about safety problems, data from HaiPro reports and literature. 4. Results Because the safety project is progressing along with the nursing, it has had little time resources. Limitations of the study are that HaiPro reports are not yet deeply analysed and observational data have only be discussed together in the group. The safety project can be seen as a good case of safety development project, which background is more in the nursing practice than in research. Anyway, we know already that in the ward 3 nursing includes lot of patient observation and assessment, when the staff do their best to prevent accidents. Project will continue and safety group has done some plans for future process. The first aim is to find practical tools to make ward safer. A few things towards the safer ward have been new shoes to patients, new wheelchairs and new patient lifting equipment. Because elderly patients lose their balance and muscle strength quickly, staff is motivated to start rehabilitation as early as possible. They help patients to get out of bed and in the ward are many walker devices. Project group have been looking information about security systems, which could alarm if a patient try to get out of bed alone. The group has not yet found any suitable bed-exit alarm system. One step towards safer ward will be new lighting system to the observation room (room is for hearth operated patients). The idea is have a lighting system were lighting help patients separate daytime and nighttime. 231

228 Next aim is to get more information about risks and solutions. HaiPro reports for the years 2009 and 2010 will be studied more closely than earlier. The information they give will be used to scenarios, which describe some typical situations where patients fall. The scenarios illustrate what kinds of patients are at risk of fall. The group has collected articles and literary sources about safety subject for staff members. In the next autumn 2011 will be a seminar, where first subject of discussion is going to be elderly patient's medication and post operation delirium. Other subject is learning to understand how the memory sick person perceives a hospital ward environment. 5. Discussion Although the project is still ongoing the safety group wants already at this stage of process pay attention to three elderly patients related issues. These are themes, which have arisen from every day nursing work but they can be found in the literature too. When an elderly patient must stay in bed, he loses his muscle strength and balance ability faster than a younger patient. Elderly patient can get postoperative delirium more likely than middle-aged. Hospitals can be confusing place especially for patients who have memory disabilities. These three themes can increase the risk of falling for elderly patients in acute ward. When an elderly person is in hospital, staff should pay attention both to the patient s physical capacity and to the limitations of memory and thought processes and to the environmental factors. In this safety project large safety subject have been looked from one limited and practical question: how to prevent elderly patients fall accidents in a surgery ward. Safety project group s conclusion is that we need tools and knowledge to take care elderly patients safety during their stay in hospital. The future will show if our safety project can produce patient safety outcomes. 7. Acknowledgements I like to say thank you to nurse Sari Ahokas and surgeon Vesa Anttila, who are members of the safety project and also to nurse head Virpi Isaksson for working together for safer ward. 232

229 References Hankonen, R Tiedon puute usein potilashaitan syy. Tehy 8/2011, 9. Heikkinen, E Sairauksista toimintakykyyn. Article in the publication: Vanhuuden voimavara. Heikkinen, Eino & Marin, Marjatta(toim.). Kustannusosakeyhtiö Tammi, Vammalan kirjapaino Oy, Vammala (Upload ) Iinattiniemi, S Fall Accidents and Exercise among a very old home-dwelling population. Acta Universitatis Ouluensis Medica D ISBN Oulu University Press. Oulu. Katznelson, R Strategies to Prevent Post-Op Delirium How to avoid this common condition of confusion following surgery. Outpatient Surgery Magazine, , (Upload ) Koskela, A Laadunhallinnan ja potilasturvallisuuden suunnittelusta uusi asetus. Sosiaali- ja terveysministeriö tiedotteet. Verkkouutinen (Upload ) Mänty, M. & Sihvonen, S, & Hulkko, T. & Lounamaa, A. (toim.) Iäkkäiden henkilöiden kaatumistapaturmat. Opas kaatumisten ja murtumien ehkäisyyn. Kansanterveyslaitoksen julkaisuja, B29/2007. (Upload ) Nivalainen, S. & Sulamaa, P Alueellinen väestönkehitys vuoteen Article in the publication: Suomi 2025, Kestävän kasvun haasteet. Hjerppe, Reino & Honkatukia, Juha (edit.) Valtion taloudellinen tutkimuskeskus. Gummerus Kirjapaino Oy, Saarijärvi, Saarnio, R The use of physical restraints in institutional elderly care. Acta Univ. Oul. D Oulu unversity press. Oulu. Sands, G. & Hignett, S. & Youde, J. & Griffiths, P. (2010). The contribution of environmental factors to elderly in-patient falls in acute facilities. Proceedings of the International Conference on Fall Prevention and Protection, Morgantown, West Virginia, USA, May (Upload ) Sosiaali- ja terveysministeriö Edistämme potilasturvallisuutta yhdessä. Suomalainen potilasturvallisuus strategia Sosiaali- ja terveysministeriön julkaisuja 2009:3. 2. korjattu painos Yliopistopaino, Helsinki. (Upload ) Voipio-Pulkki, L-M. & Inkinen, R. & Tammela, O. & Oja, K. (2009). Vaaratapahtumien raportointimenettely. Terveyden ja hyvinvoinnin laitos. Yliopistopaino, Helsinki. (Upload ) Wallenius, J Suomen potilasturvallisuusyhdistys perustettu. Ajankohtaista sivustolla HaiPro. (Upload ) 233

230 3rd parallel sessions Tuesday September 20, :10-11:50 234

231 A3 HUMAN FACTORS IN PRODUCT & SERVICE DEVELOPMENT AND ORGANISATIONAL ERGONOMICS A3.2 A case study about human factors verification of CCR/Bridge design for offshore mobile drilling rigs Yaunhua Liu A3.3 Dynamic users' field of view analysis in Virtual Reality Susanna Aromaa A3.4 Ergonomic centered innovation and product development - applied methodology merging engineering and ergonomics Anders Sundin A3.5 Enabling end-user participation in ship design Cecilia Österman 235

232 A CASE STUDY ABOUT HUMAN FACTORS VERIFICATION OF CCR/BRIDGE DESIGN FOR OFFSHORE MOBILE DRILLING RIGS Yuanhua Liu & Jan Tore Ludvigsen HMS Design & Utvikling AS, Norway Abstract Introduction: Compared to land-based installations, offshore oil and gas production face more challenges due to the remote location and harsher environment. The design and construction of offshore deepwater drilling rigs is normally required to be in line with relevant maritime operational concept and regulations, as well as with petroleum regulations. Thus, the design of the central control room (CCR) for semi-submersible drilling rigs concerns safety and efficiency in navigation and offshore drilling operation, which demands involvement of human factors assessment. Purpose: The purpose of this paper is to reveal the potential design defects identified during the human factors verification in an offshore project - PIONEER, as well as to pinpoint challenges and reflections concerning implementing human factors issues in CCR design for mobile offshore drilling rigs. Method: During the human Factors verification, field inspection and semi-structured interviews were carried out during survey onboard the rig, which provided basis and data for Function and task analysis. A CRIOP-based (Crisis Intervention in Offshore Production) checklist was also adopted to verify design weaknesses related to layout arrangement, control & safety systems, working environment and Human-Machine Interface (HMI) etc. in the CCR design. Results: The results showed that the identified potential design defects are mostly relevant to manning plan and strategy, control consoles, layout arrangement and location of emergency handling. The implications from the findings could be seen as three aspects: (1) challenges related to inconsistences between maritime and petroleum regulations, (2) limitations related to ergonomic design of control consoles in CCRs; (3) challenges related to adoption of CRIOP- checklist during human factors verifications; and (4) constrains due to inborn problems of large offshore projects. Conclusions: The conclusion was that improvements on the product design and verification tool should be aware of and considered by human factors engineers and industrial manufacturers in order to achieve good ergonomic design of CCRs on offshore oil rigs. In addition, how to reduce the risks caused by various inborn project problems as well as how to implement and ensure human factors design efficiently in large engineering projects should be studied and considered in offshore oil & gas industries. Keywords: Offshore Drilling Rigs, Human Factors, CCR, CRIOP-based Checklist, Control Console. 236

233 DYNAMIC USERS FIELD OF VIEW ANALYSIS IN VIRTUAL REALITY Aromaa, Susanna & Helin, Kaj VTT Technical Research Centre of Finland, P.O. Box 1300, FI Tampere, Finland 1. Introduction 2. Companies are starting to use more Virtual Reality (VR) technology as a part of their design processes and this establishes good ground for field of view (FOV) analysis especially in machine cabin design. Evaluating FOV in VR can also have challenges, because the evaluation of users FOV is not always a simple thing: it relates to task in hand; the situation is usually dynamic and VR affects to the behaviour of the user. The possible answer to meet these challenges could be more effective and analytic FOV analysis instead of gut feeling and expert evaluation what are often used today. New kind of dynamic approach for evaluating FOV would support the expert evaluation and improve the use of VR system in design process. Also the usability and acceptance of the final product would improve. 2. Objectives The main objective is to make a tool for analysing field of view in VR more efficiently and also to have additional information to support designers when making design decisions. 3. Methods The dynamic and automatic evaluation tool for FOV in VR was made in Virtools software. The head tracking system was used to track dynamic head motions. Also virtual radiating ray was made for the human viewing area to recognise which objects are in FOV. Based on that, the head tracking system can calculate user s real head position in virtual environment and calculate also the objects in FOV. 4. Results As a result there is an automatic and dynamic analysis method to analyse FOV especially in cabin design. It is possible to measure the proportion of how much some objects were seen while the user was performing the task. The other possibility is to measure the masking effect of the cabin structure. The analysis will give support for making decisions when comparing two design solutions. 5. Discussion/conclusions The use of head tracking gives good possibilities to evaluate dynamic FOV of the user comparing to static human model use. There are still many uncertainties that can affect to results and needs to be considered while making FOV analysis e.g. users motions are not necessary realistic in VR. It is important also to keep in mind that this is rough estimate of FOV, because it is based on head motions not eye motions (eye tracking was not used). Although the use of this kind of evaluation brings a lot of uncertainties, it also gives additional information for designers and experts to decide which FOV solutions are better and also why. 237

234 ERGONOMIC CENTERED INNOVATION AND PRODUCT DEVELOPMENT APPLIED METHODOLOGY MERGING ENGINEERING AND ERGONOMICS SUNDIN, A 1 1. Group Ergonomics/HMI, Department Body & Interior, Semcon SE Göteborg, Sweden Many product developers have not still incorporated human factors in an effective way, instead treated as being aside the normal work. This often means ergonomics specialist carrying out the work and other actors not having enough knowledge on how and when to consider human factors. This paper describes some means and practical methods within ergonomics, including Human Machine Interaction, HMI, practiced in projects with a number of companies developing products, where the work with ergonomics/hmi are incorporated into their daily product development processes. Keywords: Ergonomics, HMI, Methodology, Product development Introduction In product development the focus is to develop a product that thereafter will be produced, marketed, sold and used. This first phase, product development, usually includes industrial design, mechanical design, strength or aerodynamic calculations and electronics etc. In all these phases requirements are set and followed, often in detailed and for many attributes. Before product development, customer needs are usually collected. Historically, ergonomics has not always clearly been on the table in this product development process, also within the collection of user needs and expectations. The later years this has improved and especially larger companies put efforts to include ergonomics into the ordinary development work. However, many developers have still not incorporated human factors in an effective way, instead treated as being aside the normal work. This often means ergonomics specialist carrying out the work and other actors or stakeholders within the company not having enough knowledge on how and when to consider human factors. Objectives This paper describes examples of means and practical methods within ergonomics, including Human Machine Interaction, HMI, used in projects with a number of companies. The work has been carried out as consultants in cooperation with the companies. The methods have been used for e.g. car-, truck- and white goods products including physical aspects as well as interaction aspects for displays etc. The methodologies used merge the knowledge and work processes used in engineering product development and the ones used in ergonomics development work. Normally the company stakeholders or people involved in the project are industrial designers or designers. The consultants are educated within engineering and ergonomics/hmi. Methodology To be able to work effectively together with a company supporting them in their daily product development work focusing on human factors, it is important to present and use a practical methodology. The methodology should be pragmatic but supported and in many parts based on science. The main approach used in the mentioned projects is named Semcon Ergonomics/HMI Project Methodology (Figure 1), where a participatory ergonomics approach is strived for, containing the work phases Background, Requirement development and Concept development and 238

235 verification. Those phases surround or interact with the core operation design of the product, i.e. Controls and Interface Design in Figure 1 regarding HMI. Figure 1. Semcon HMI Project Methodology. A similar methodology scheme exists for physical ergonomics The participatory approach In the projects the striving is to reach a participatory approach, meaning that users and also different competencies are involved in the work. Usually a group of industrial designers and designers are formed around the consultant. Normally also the consultants are two persons present, representing different knowledge and background. Supporting documents For each action/box in each phase in Figure 1 above there are a document describing the suitable steps to be taken in the project with the company. In Figure 2 below is shown an example of the instructions given in the separate document to support the consultant using the Semcon HMI Project Methodology scheme shown in Figure 1 above. 239

236 Figure 2. Example of instructions (in Swedish) supporting each box in the scheme in Figure 1. Regarding requirements setting or development, it is usually a difficult and time consuming task to be made for each product or product family. Here, most work should be put, this to be able to succeed on the market and meet legally and customer demands on a local or a global market. This work leads to quite thorough requirements documents developed close together with the company, then handed over to be used in their daily work process. Often these requirements documents are complemented with Ergonomics Process Documents, written after research within the company, to be used as guides to naturally incorporate the ergonomics work with the daily engineering work processes. To even more support the daily use and fulfillment of requirements and recommendations, 3D ergonomic requirements models can be developed with the help of computer tools. 3D ergonomic requirements models Digital Human Modeling (DHM) tools have for a long time been used to facilitate this work and consider ergonomics early in the product development process. However, even though this tool is used, the product developers have difficulties finding easy access to ergonomic recommendations and requirements needed for a proper study. Usually facts are spread out in paper folders or digital folders around the company. In Sundin (2010) it is illustrated how the DHM tool Delmia V5 240

237 Human was used to build 3D ergonomic requirements models for a specific automotive cabin development branch. Based on a foundation of international recommendations and regulations, e.g. EN, ISO, SAE, as well as company-specific demands, CAD models were developed describing the ergonomic requirements as envelopes or planes. The models covered outer visibility, maximum and comfort reach and foot reach. Furthermore, inner visibility was also included covering part of the HMI requirements. It is illustrated how these types of models can be used as an effective tool in ergonomics requirements handling as well as for time reduction in product development. Results Results from described typed of projects include design proposals and methodology documents, e.g. evaluation methods and templates, as well as requirement data (Figure 3). Another example of results of the work of merging ergonomics data into engineering data is the creation of 3D requirement models as described above, based on standardization documents, e.g. ISO, EN (Figure 4). Figure 3. Requirement data document 241

238 Figure 4. Example of 3D ergonomic requirement models based on standardization and recommendations. To the left, a reach restrictions. To the right, vision restrictions. Discussion Working in projects together with companies striving towards an improved ergonomics approach within their product development process and products, the importance of incorporating and merging ergonomics into normal development is clear, but yet not easy. The practical work methods developed and used covers both the incorporation of the science of ergonomics, e.g. anthropometrics, mental models luminance contrast levels etc., via the use of different methods, but also as important, the highlight and improvement of the process of ergonomics development and evaluation in a company, e.g. touched upon by Berlin (2010) and by her denoted as the infrastructure of ergonomics. Shortly, the process of ergonomics involves e.g. what stakeholders that are involved, responsibility for ergonomics etc. Also included is how to denote or name different actions or areas covering ergonomics. This is important to be able to communicate and sell the importance, and the results, of ergonomics focus between ergonomists and other competencies or stakeholders in a company. Similar thinking has been made by Parviainen (2011) including how to find product, production and ergonomics metrics and other information and be able to communicate this also with marketing departments and clients/users. Biography Dr. Anders Sundin is the Manager of Ergonomics/HMI at Semcon. His experience lies mainly within the automotive and space industry. In 2001 he received his doctoral degree within ergonomics visualization and human simulation and how these tools can improve workplace design. During three years he worked for ESA and NASA with the Cupola module, launched to the International Space Station in 2010, where he was responsible for the ergonomics verification of astronaut tasks through digital human visualization and simulation. Since 2005 the focus for his group of 16 consultants has been on interface design, physical ergonomics and ergonomics simulation for different types of products mostly aimed for road, rail and space applications. References Berlin, C Production ergonomics evaluation: needs, procedures and digital human modeling tools, Chalmers University of Technology, Licentiate Thesis. Parviainen, E. Combination of technical and human factors in co-operation with the customer, Nordic Ergonomics Society yearly conference, NES 2011, Oulu, Finland, Sundin A., Landén J., Hedberg A., Holler J. Development of 3D Ergonomics Requirement Models for Cabin Development, AHFE 2010, July, Florida, USA. 242

239 ENABLING END-USER PARTICIPAPATION IN SHIP DESIGN Österman, C 1, Berlin, C 2 and Bligård, L-O 2 1 Department of Shipping and Marine Technology, Chalmers University of Technology, SE Gothenburg, Sweden 2 Department of Product and Production Development, Chalmers University of Technology, SE Gothenburg, Sweden The globalized nature of the shipping industry poses challenges to a traditional set-up of a collaborative design and development team involving end-users. The present study explores aspects of end-user involvement and three different 3D models abilities to act as boundary objects in a ship design process. The preliminary results indicate that the evaluation methods and representations used in the study produced valuable design feedback. With relatively small means, the procedure supports the benefits of employee participation, contributing to a safe and efficient ship design and subsequent operation. Key words: participatory ergonomics, work space design, ship design Introduction Involving users in the design and development processes of new products, systems and workspaces has become increasingly important (Launis 2001). End-users contribute important workplace knowledge on processes, tasks, equipment, and potential risks. It is further suggested that a participatory approach to ergonomics creates a sense of ownership and commitment to agreed solutions, more rapid implementation of workplace changes, and increased learning within the organization (e.g.wilson and Haines 2001; Vink, Koningsveld et al. 2006). The earlier in the design process the intended end-users can be involved, the greater the possibility to improve production technology and work environment in a cost-efficient way (Hendrick 2003). Sweden has a long tradition of cooperation between employers and employees towards a good working environment and employee participation in the planning of new or altered workplaces, work processes, methods and organizations is legally enforced by the Work Environment Act (SFS 1977:1160). The present study concerns the maritime domain where national legislation is supplemented by regional and supranational legal frameworks. Although participation in design may not be expressed as explicitly as in the Swedish Work Environment Act, employee participation in maritime occupational health and safety work is mandated in several conventions, codes and guidelines issued by the International Maritime Organization (IMO) (e.g. IMO 1997, 2002, 2006). However, assembling a collaborative design team of designers, manufacturers and end-users can be a logistical challenge when planning a major conversion or the building of a new ship. Due to the globalized nature of shipping, these stakeholders are often scattered both geographically and organizationally. The range of organizations and decision-making structures involved in the shipping industry can be illustrated by the typical example of a Norwegian-owned ship, built in China by a Dutch-owned yard, flying the Liberian Flag, manned by British officers and Filipino crew, carrying Iranian crude oil to Japan. Furthermore, to the extent that seafarers as end-users do participate in this design process, it is traditionally addressed by an invitation to comment on technical drawings, often 2D paper drawings. With different educational and professional backgrounds, the seafarers command of technical drawings and ability to communicate in 243

240 engineering terms with designers can vary greatly, and thus further complicate a collaborative design process. It is therefore necessary to find other solutions to elicit, communicate and apply the end-users knowledge and experiences into the ship design process. The present paper reports on some preliminary findings from a study concerning several aspects of enduser involvement in a ship design process, in this case limited to a ship bridge. Focus is placed on the ability of use scenario workshops and three simple 3D representations to act as boundary objects (Broberg, Andersen et al. 2011) and elicit design feedback from seafarers as end-users. Objectives The objectives of the present study are to explore possibilities for including seafarers in the ship design process in a cost-efficient manner, and to investigate whether simple representations of a ship bridge can generate valuable information. The study seeks to answer the following questions: (1) what kinds of comments from end-users can be elicited using simple 3D representations, and (2) what kind of input towards the design process can such 3D-mediated discussions contribute? Methodology Six groups consisting of three nautical cadets in their third or fourth year at a Swedish merchant marine academy were asked to evaluate different representations of a ship bridge, with respect to work environment and workplace efficiency. The ship bridge was presented in four different ways: as a 2D paper drawing, a 3D drawing in a CAD program, a 1:16 paperboard model, and as a 1:1 plywood mock-up. In a use scenario workshop (cf. Broberg 2010) featuring three different scenarios (during mooring, in a busy fairway and a specific work operation on deck), the cadets gave feedback on each of the representations. The scenarios were first responded to individually and later in groups. Each group was first shown the 2D representation, followed by the three 3D representations in succession (table 1 shows the succession in which each group was introduced to the three 3D representations). A written questionnaire was used to elicit more specific input about the models. Table 1 the order in which the participants were introduced to the different models Cadet group 1 st model 2 nd model 3 rd model 4 th model Group 1 1:16 CAD 1:1 Group 2 CAD 1:16 1:1 Group 3 2D drawing of CAD 1:1 1:16 Group 4 the ship bridge 1:16 1:1 CAD Group 5 1:1 1:16 CAD Group 6 1:1 CAD 1:16 Each group session was introduced by one of the researchers, explaining the plan for the session and the use scenarios. Following this, each participant was encouraged to interact freely with each representation by physically manipulating and testing it in a suitable way, in order to trigger evaluative answers to each use scenario. These answers were first written down individually and then discussed in each group. Throughout the sessions, each participant had an information brochure at their disposal, with ship particulars and photographs of the ship and various realistic work operations. At the end of the (approx. 1.5 hour) sessions, the participants were asked to rank and comment upon their perceptions of the following use and design aspects of the models: Assessment of movement space on the bridge Assessment of field of vision through windows Assessment of field of vision for instrumentation, controls and monitors 244

241 Assessment of reach and accessibility for instrumentation, controls and monitors Assessment of working space on the bridge Most convincing Discussability (if the model trigger and maintain discussions on relevant topics) Allowance for considering alternative solutions Easiest to modify Works best in practice The ranking was first done individually and then discussed within the group. The model interactions and group discussions were audio and video recorded for subsequent analysis and coding (Bryman and Bell 2007). ResuLts All four representations generated comments relevant for a real ship design team to consider. At large, the written individual comments and the following group discussions referred to issues important for a safe and efficient ship operation. It was also noted that the participants were able to relate past seafaring experiences to the suggested design. 4.1 Results of use scenario workshops The 3D representations were considered most helpful for envisioning the workplace design and enabling user participation. Specifically, the participants appreciated the possibility to be able to walk in the 1:1 mock-up, using their own bodies as a size reference when evaluating the ship bridge design. However, it was believed by most participants that this option was less likely to be used in a real ship design project. With no prompts apart from the described scenarios, participants were able to give detailed feedback about how different layout details would affect their ability to work in the proposed layout. The spontaneous comments considered following design aspects: Visual display units; the placing, angle and using of the radar and electronic chart display systems. Field of vision; deck and bridge overview during manoeuvring, work and mooring operations, possibility to see instruments. Collaboration; bridge team cooperation (master, officer on watch and helmsman) and bridge deck crew cooperation during normal and emergency operations. Possibility to have eye contact during operations. Space and layout; possibility to move around on the bridge without running in to lurking chairs and console corners, accessibility of various controls, instruments and communication equipment, height adjustable worktables and panels. Operator seats; space-demanding, how are the seats placed and used, and possibility to move or remove the seats. Many of the participants comments covered design aspects that a design team would benefit from taking into account, but would be difficult to ascertain without first-hand user experience. These comments regard movement patterns, multiple uses of the same workspace or surface, vision-related requirements, comfort concerns, and behaviours related both to work and leisure, recognizing the ship as a social as well as a working environment. Also, the elicited responses to different functional aspects suggested the participants priorities in their workflow. However, it was observed that many function-related comments signalled differing mental models among the participants regarding size and function of the rest of the ship (e.g. the parts visible on the 2D drawing, but delimited from the 3D model representations). Sometimes, participants gave feedback on design details based on ships they had work experience from, rather than the actual ship represented in the brochure. 245

242 4.2 Results of ranking Pending a more in-depth analysis of the ranking results, the paper focuses on comments and reasons given by participants for their preferences of one model over another. Table 2 show the categories of comments related to the ranking of the models. The results are based solely on the questionnaire results on an individual level. Table 2 comments related to the ranking of the models Model + - 2D 1:16 1:1 Easy to modify Gives good overview Total overview gives better decision support Accustomed to work with 2D Easy to adapt to No computer or carpentry skills needed to build Can be distributed/sent Gives good overview Easy to discuss Easy to understand Cheap, best cost-benefit in practice Superior for assessing movement Superior for assessing field of vision Ability to stand and walk around in the model yourself makes the model easy to relate to Ability to demonstrate something Gives a good feel for the working environment Easy to assess distances Best because it s more like a real bridge you can walk around in Gives good and concrete discussions Good for coming up with alternative solutions - Offers no sense of heights [in reference to work tables and panels] - Cannot be distributed/sent - Difficult to get an overview - Cannot be sent; you have to be there CAD and 2D demands equal effort to change, but the change is more tangible in 3D CAD Preferably, standard modules, benches etc. should be changeable and possible to move around Can be distributed/sent The mean of all the ranked design aspects show a general appreciation of the 1:1 model, its use in practice is however perceived as less likely. This was partly due to its restricted mobility, but also believing that building a 1:1-mock-up would be both difficult and expensive. Rather, a combination of a 2D drawing for the holistic overview, and one of the 3D models as a complement for easy assessment of movement space, field of vision, reach and accessibility was perceived to work best in practice. Without being prompted, the participants also considered economic aspects when evaluating the models use for a real ship design process. Several comments concerned the costs and resources for making and modifying the different models. The order in which the models were presented inevitably affects feedback from participants since they gradually relate models more and more to each other. Less and less unique comments on the models were made towards the end of the sessions, probably due to fatigue and the possibility to refer back to previous comments. Discussion The fact that all models were commented upon and could elicit discussions among the participants was interpreted as an indication that the models act as boundary objects. Many anecdotes from previous experiences were triggered and the participants seemed to agree that the models were to be interpreted 246

243 and evaluated as a real ship bridge during discussions. Most comments concerned use issues and functional requirements related to working on the bridge. The 3D models were all on the same abstraction level. No instruments, controls or interfaces were visualized. Their absence was commented sparingly by participants. The ability of the participants to relate their previous experience to the design proposal is believed to benefit a design team, who may have little knowledge or experience of practicalities concerning operation of a ship. Furthermore, as the participants in this study were all cadets with limited seafaring and shipyard experience, it is firmly believed that seafarers that are either more experienced, or familiar with the ship, could elaborate and contribute further on the design. Using cadets for the study also meant an absence of social context that can be expected in a group of colleagues with formal and informal hierarchies. Nor can anything be said on how much they weighed the consequences of their feedback, since there were no responsibility situations where the participants would be affected by the decisions taken on design proposals had it been a real ship. The unsolicited comments regarding economic constraints on the models show that financial aspects are considered when evaluating the feasibility of assembling a collaborative design team and using the models as boundary objects in a real ship design process. It was however noted that the participants estimations of difficulties, costs and necessary resources to make the models were repeatedly underestimated for the 2D and 3D CAD-models, but overestimated for the scale models. Yet, despite this overestimation, the scale models and especially the 1:16 model were still considered to be worthwhile from a cost-benefit perspective. Conclusions Despite their relatively limited work experience, the participating cadets were able to give useful comments transferrable to valuable input in a ship design process. All representations received comments from all participants, which was interpreted as an acceptance of the models as boundary objects. The 3D-models elicited a variety of comments, for example anecdotes from previous experience; advantages and disadvantages related to specific use situations; and tangible suggestions for engineering changes regarding visual display units, field of vision, collaboration, space and layout and operator seats. In conclusion, preliminary results indicate that the evaluation methods and representations used in the study would be useful in a real ship design process and probably even more so with experienced seafarers participating. With relatively small means, the procedure supports the benefits of employee participation, contributing to a safe and efficient ship design and subsequent operation. References Broberg, O Workspace design: a case study applying participatory design principles of healthy workplaces in an industrial setting. International Journal of Technology Management 51(1): Broberg, O., V. Andersen & R. Seim Participatory ergonomics in design processes: The role of boundary objects. Applied Ergonomics 42(3): Bryman, A. & E. Bell Business Research Methods. New York, Oxford University Press. Hendrick, H. W Determining the cost-benefit of ergonomics projects and factors that lead to their success. Applied Ergonomics 34: IMO Human element vision, principles and goals for the organization. Resolution A.850(20). London, International Maritime Organization. IMO International Safety Management (ISM) Code and Guidelines on implementation of the ISM Code. London, IMO Publishing. 247

244 IMO Guidelines on the basic elements of a shipboard occupational health and safety programme. MSC-MEPC.2/Circ.3. IMO. London, International Maritime Organization. Launis, M Participation and Collaboration in Workplace Design. In W. Karwowski (Ed.) International Encyclopedia of Ergonomics and Human Factors. London and New York, CRC Press. Vol II, Wilson, J. R. & H. M. Haines Participatory Ergonomics. In W. Karwowski (Ed.) International Encyclopedia of Ergonomics and Human Factors. London and New York, CRC Press. Vol II, Vink, P., E. A. P. Koningsveld & J. F. Molenbroek Positive outcomes of participatory ergonomics in terms of greater comfort and higher productivity. Applied Ergonomics 37(4):

245 B3: PHYSICAL ERGONOMICS B3.1 Perceived physical working conditions and sickness absence - a four year follow-up in the food industry Anna Siukola B3.2 Development, implementation and dissemination of RAMP: Risk management Assesment tool for Manual handling Proactively Linda Rose B3.3 Whole-body vibration, postural load and working time during driving agricultural vehicles Veli-Matti Tuure B3.4 Methodology to compare physical ergonomic of heavy hand tools - a case study on power-cutters Anna-Lisa Osvalder B3.5 User interfaces at work: the cost of inconsistency Virpi Kalakoski 249

246 PERCEIVED PHYSICAL WORKING CONDITIONS AND SICKNESS ABSENCE A FOUR YEAR FOLLOW-UP IN THE FOOD INDUSTRY Siukola A 1, Virtanen P 1, Neupane S 1, Nygård C-H 1 1 School of Health Sciences, University of Tampere, Tampere, Finland There is little knowledge on how changes in working conditions interact with changes in sickness absence. The aim of this study was to analyze whether perceived changes in physical working conditions are associated with changes in registered sickness absences among employees (< 50 yrs and 50 yrs) in the food industry. The results showed that increased poor working postures, were associated to an increase in sickness absence, especially in the older group. Key words: physical working conditions, sickness absence, change 1 Introduction Poor physical working conditions are known to be associated with high sickness absence rates (Voss et al 2001; Lund et al 2006). Despite of the widely explored sickness absence phenomenon there is little knowledge on how changes in physical working conditions interact with changes in sickness absence. There are a few studies (Vahtera et al 2000; Head et al 2006) about how changes in psychosocial working conditions are associated with changes in sickness absence, but to our knowledge there are no corresponding studies about changes in physical working conditions and sickness absence. This study was conducted in a food industry, which is known for its demanding physical conditions, consisting of assembly-line work, repetitive and monotonous movements, hectic pace of work, a lot of standing and carrying or lifting of heavy loads (Messing et al 1998; Savinainen et al 2004). The work also includes high environmental exposure (e.g. heat, cold, draught). In addition the branch has the highest sickness absence rate among the industries in Finland (Työaikakatsaus 2010). Age is a noteworthy factor especially in physical demanding work. It has been shown that the significance of perceived working conditions depends very much on the age of the workers (Nygård et al 1997). A common fact is that work ability decrease (Tuomi et al 1991; Gamperiene et al 2008) and sickness absence days increase with increasing age (Isacsson et al 1992), but to our knowledge there are no studies about the interaction of sickness absence and perceived working conditions among workers of different age. 2 Objectives The aim of the present study was to analyze the association of changes in perceived physical working conditions with changes in sickness absence days in food industry employees in younger and older (< 50 yrs and 50 yrs) employees. 3 Methods Surveys in years 2005 and 2009 were collected in a large food industry company in Finland. Sickness absence data from one year previous to the surveys was combined to questionnaires if an employee was consented to the study and had an employment 250

247 contract for at least six months in both 2004 and 2008 (N=679). Sickness absence days were expressed as days per person year. Perceived physical working conditions included six questions about environmental exposure (draft, noise, indoor climate, lightning, heat and cold) and repetitive and monotonous movements and poor working postures. Environmental exposure was asked on a Likert-scale going from 1 (low) to 5 (high) and summed up in to a sum score variable ranging from 1 to 5. Movements and working postures were asked on a same scale but analyzed as single questions. Changes of the physical working conditions were calculated by subtracting the values of the year 2005 from the values of the year Sickness absence days were calculated respectively from years 2004 and Multifactor analysis about changes in sickness absence and perceived physical factors was conducted using linear regression models with enter method with their baseline measures and with age (not in the analysis done by age group), gender and work task (blue-collar / white-collar workers). The mean age of the study subjects was 41 years (SD 9.7) and 64 % (n=433) of them were women. The subjects were divided in to age groups below 50 years (76 %, n=517) and at least 50 years (24 %, n=162). 4 Results The sickness absence days had increased statistically significantly (from 6.0 to 9.0 days per person year, p<0.001) from the year 2004 to 2008 among all employees. Changes in days by age group were from 6.0 to 8 days in the younger, and from 6.0 to 12.5 days in the older group, respectively. Perceived physical conditions improved in the younger group and remained the same in the older group during the follow-up (Table 1). Table 1. Distributions of perceived physical factors (mean, SD, scale 1 to 5) in the baseline year 2004 and in the follow-up year 2008 and their statistical differences (p-value) among two age groups (<50 years and 50years). <50 years (n=517) 50years (n=162) baseline 2004 follow-up 2008 p-value* baseline 2004 follow-up 2008 p-value* Environmental exposure Repetitive and monotonous movements Poor working postures 2.7 (0.78) 2.6 (0.76) (0.85) 2.5 (0.88) (1.28) 2.9 (0.76) (1.21) 2.8 (1.20) (1.28) 2.9 (1.23) (1.18) 2.7 (1.20) * analyzed by paired samples test In Table 2 is shown that only one factor, increased poor working postures, was associated to a change in sickness absence (p=0.017). This result remained in the analysis by age group (Table 3). In the older group, among them who perceived an increase in poor working postures, there was a statistically significant association with an increase in sickness absence (p=0.045), but in the younger group none of the changes in physical conditions were associated to a change in sickness absence. 251

248 Table 2. Associations of the change of sickness absence days from year 2004 to year 2008 and change of perceived physical and working environment from 2005 to 2009 among all employees (N=679). Change of Adjusted by age, gender, occupational status, and baseline-factors 1 Unstandardized coefficients β All (N=679) (95% CI) for β environmental exposure ( ) repetitive and monotonous ( ) movements poor working postures ( ) Baseline factors: physical work environment factors in the year 2005 and sickness absence days in the year 2004 p Table 3. Associations of the change of sickness absence days from year 2004 to year 2008 and change of perceived physical and working environment from 2005 to 2009 by age group. Adjusted by gender, occupational status, and baseline-factors 1 Change of <50 years (n=517) 50years (n=162) Unstandardiz ed coefficients β (95% CI) for β p Unstand ardized coefficients β (95% CI) for β p environmental exposure repetitive and monotonous movements poor working postures ( ) ( ) ( ) ( ) ( ) ( ) Baseline factors: physical work environment factors in the year 2005 and sickness absence days in the year Discussion In present study increased amount of poor working postures was related to increased sickness absence days, especially among the older employees. The significant association between poor working postures and sickness absence among the older employees could partly be explained by a decrease in muscular strength especially after the age of 50 years (Nygård et al 1991), which means that the older ones could have difficulties with keeping an ergonomically good posture. Physical working conditions were a more prominent factor in present study than the environmental exposure. This result supports the study of Allebeck and Mastekaasa (2004) who concluded that biomechanical factors (e.g. poor working postures) are more important to sickness absence than external conditions (environmental exposure). The strength of this study is the follow-up design and the combination of the sickness absence register and a questionnaire. It can be seen as a weakness of our study that we concentrated only on physical factors, even if Laaksonen et al (2010) reported that physical conditions, including heavy workload and environmental exposures, are more significant predictors of sickness absence than psychosocial working conditions. 252

249 Nevertheless, there are many factors affecting sickness absence of individuals, for example their psychosocial conditions at work (Duijts et al 2007) and factors outside of work (Melchior et al 2003) and local communities in which they live (Virtanen et al 2010). Thus, it is possible that even if physical working conditions improve, it may not be enough to decrease sickness absence, because sickness absence is associated with many other things in working life but also outside of it. 6 Conclusions According to this study working postures in physically demanding working conditions in the food industry should still be improved by suitable ergonomic measures, especially among the older employees. 7 References Allebeck P, Mastekaasa A Swedish Council on Technology Assessment in Health Care (SBU). Chapter 5. Risk factors for sick leave - general studies. Scand J Public Health Suppl 63, Duijts SF, Kant I, Swaen GM, van den Brandt PA & Zeegers MP A metaanalysis of observational studies identifies predictors of sickness absence. Journal of Clinical Epidemiology 60, Gamperiene M, Nygard JF, Sandanger I, Lau B, Bruusgaard D Self-reported work ability of Norwegian women in relation to physical and mental health, and to the work environment. J Occup Med Toxicol 3,8. Isacsson A, Hanson BS, Janzon L & Kugelberg G The epidemiology of sick leave in an urban population in Malmo, Sweden. Scandinavian Journal of Social Medicine 20, Laaksonen M, Pitkäniemi J, Rahkonen O & Lahelma E Work arrangements, physical working conditions, and psychosocial working conditions as risk factors for sickness absence: bayesian analysis of prospective data. Annals of Epidemiology 20, Lund T, Labriola M, Christensen KB, Bultmann U, Villadsen E Physical work environment risk factors for long term sickness absence: prospective findings among a cohort of 5357 employees in Denmark. BMJ 332, Melchior M, Niedhammer I, Berkman LF & Goldberg M Do psychosocial work factors and social relations exert independent effects on sickness absence? A six year prospective study of the GAZEL cohort. Journal of Epidemiology and Community Health 57, Messing K, Tissot F, Saurel-Cubizolles MJ, Kaminski M & Bourgine M Sex as a variable can be a surrogate for some working conditions: factors associated with sickness absence. Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine 40, Nygård CH, Huuhtanen P, Tuomi K & Martikainen R Perceived work changes between 1981 and 1992 among aging workers in Finland. Scandinavian Journal of Work, Environment & Health 23 Suppl 1, Nygård CH, Eskelinen L, Suvanto S, Tuomi K, Ilmarinen J Associations between functional capacity and work ability among elderly municipal employees. Scandinavian Journal of Work, Environment & Health 17 Suppl 1, Savinainen M, Nygård C & Arola H Physical Capacity and Work Ability among Middle-aged Women in Physically Demanding Work - a 10-year Follow-up Study. Advances in Physiotherapy 6,

250 Tuomi K, Eskelinen L, Toikkanen J, Järvinen I, Ilmarinen J & Klockars M Work load and individual factors affecting work ability among aging municipal employees. 17, Työaikakatsaus Elinkeinoelämän keskusliitto [The review of working time 2009.Confederation of Finnish Industries]URL: Vahtera J, Kivimäki M, Pentti J & Theorell T Effect of change in the psychosocial work environment on sickness absence: a seven year follow up of initially healthy employees. Journal of Epidemiology and Community Health 54, Virtanen P, Vahtera J, Nygård CH Locality differences of sickness absence in the context of health and social conditions of the inhabitants. Scand J Public Health 38, Voss M, Floderus B, Diderchsen F Physical, psychossocial, and organisational factors relative to sickness absence: a study based on Sweden Post. Occupational and Environmental Medicine 58,

251 DEVELOPMENT, IMPLEMENTATION AND DISSEMINATION OF RAMP: RISK MANAGEMENT ASSESSMENT TOOL FOR MANUAL HANDLING PROACTIVELY Rose, L 1, Lind, C 1, Franzon, H 2, Nord Nilsson, L 3, Clausén, A 3 1 KTH, The Royal Institute of Technology, School of Technology and Health/ Division of Ergonomics, Alfred Nobels Allé 10, Huddinge, Sweden (SE); 2 Arla Foods, Lindhagensgatan 126, Stockholm, Sweden. 3 Safety, Health and Environment, Global Methods Scania CV AB, Södertälje, Sweden. This paper describes an on-going project with the main objective to develop, implement, and disseminate a freely accessible computer-based assessment tool for physical ergonomics, the Risk Management Assessment Tool for Manual Handling Proactively, RAMP. The project is conducted in seven steps, in close co-operation between researchers and key company stakeholders, using an interactive research methodology. Results include a specification of requirements that the RAMP should meet. Difficulties of developing models of this kind and possible benefits of using such a tool are discussed. Keywords: model, physical ergonomics, work related musculoskeletal injuries, manual handling, interactive research methodology 1. Introduction This paper describes a three-year project that started in 2010 after an initiative from Arla Foods. They proposed to form a project for the development and implementation of a free, user-friendly tool focussing on physical ergonomics and a process to initiate practical work environmental improvements in their different sites. The company had acknowledged a need for a risk assessment tool to assess non-paced work tasks with a high manual handling component. In Swedish industry, there are still many instances in which manual handling tasks are performed. Such tasks often involve handling heavy loads in awkward postures in repetitive motions. It is not unusual to manually handle goods that cumulatively weigh several thousand kilograms during a work-shift. Consequently, work related musculoskeletal disorders (WMSDs) are still frequent (Afa, 2008) and costly for companies and for society (Eklund et al, 2007; Regeringskansliet, 2008). An important part of companies systematic occupational safety and health (OSH) work is to assess the risk of developing WMSDs for different work tasks in order to be able to prioritize improvement initiatives. Work environment analyses are also needed as a base for well-informed strategic decisions concerning production methods and logistics to secure good quality and productivity. Many companies have a need for a MSD risk assessment tool and some companies have developed their own tools, such as Volvo s BME and Saabs BUMS. However, such methods are usually not freely accessible, are designed to fit the specific company s organization, and are developed for special types of work, such as work at production lines with regulated time frames 255

252 for work tasks. Furthermore the validity and reliability of these tools is usually not published in scientific journals. The Swedish Work Environment Authority has called attention to the lack of generally applicable systematic methods for analysis, assessment and forming improving actions (Carlsson, 2009). Further, Törnström (2007) and Falck (2009) have stated that available methods are not sufficiently specific to be used to form action plans for improvements. In the case of Arla Foods, expertise in ergonomics is available through the company's occupational health services, which often have an individual perspective. Often the ergonomists use an individual perspective. In this project, Arla Foods believes that for optimal results, a broader perspective is required which also includes addressing technical and organizational requirements. In addition, regulatory requirements should be respected and sometimes even certain standards followed. The two large companies participating in the project, Arla Foods from the food industry and Scania from the automotive industry, need to analyse manual handling intensive work tasks. This includes tasks found within logistics, manual picking work, feeding semi-automatized machines, handling material between work stations and warehouse work. Among the available risk assessment methods none has been identified as possible to use for the type of manual handling work at the companies in this project. The tools available do not provide sufficient detail for adequate assessments or have the capability for suggesting relevant actions for improvement. 2. Objectives The main objectives of the project are to develop, implement, and disseminate a freely accessible computer-based assessment tool for physical ergonomics. The tool, called RAMP management Assessment tool for Manual handling Proactively will not only be used to assess the risk of work tasks such as warehouse and hand picking work, but will also provide a structure to analyse ergonomic actions needed for potential improvement. In addition to developing the tool, a second objective of the project is to study the tool implementation process. More broadly, the aim of the project is to contribute to the decrease of WMSDs. Risk 3. Methods and organisation The project is conducted with a joint collaboration between researchers from KTH (the Royal Institute of Technology) and participants from industrial companies, mainly in the food and automotive industries (Arla Foods and Scania). The project is mainly financed by AFA Insurance. The project s research and development (R&D) team consists of key actors from these three organizations. An interactive research approach is used. This method emphasizes joint knowledge creation meaning the research is conducted together with the participants (Svensson, 2002). The project is conducted in seven steps, in close co-operation between researchers and key company stakeholders. The project begins with a needs analysis and specification of requirements for the tool as well as a study of the existing methodologies in use. These initial steps are followed by model and tool development, testing, implementation, and evaluation. In the latter part of the project, results will be gathered and disseminated. Over the course of the three-year project, individual meetings as well as the process of interactive research will be documented. 256

253 A reference group is linked to the project. This group includes representatives from participating companies, parties associated with the labour market, and the Swedish Work Environment Authority. The reference group forms a platform for discussion, knowledge transfer and advice in a broader network that gives valuable input into the project and highlights needs of different stakeholders. The RAMP tool will initially be tested at five different sites within the two main companies participating in the project. In a later stage it will be tested and evaluated within these companies and in addition within two small and two medium sized companies. 4. Results To date ergonomic analyses and discussions with different stakeholders at 10 production sites within Arla Foods and Scania have been carried out. Figure 1 illustrates some of the manual handling tasks studied. In project research thus far, the R&D team has developed 1) a first specification of requirements for the RAMP, derived by discussions in meetings with different stakeholders of the participating companies and researchers, and also by analysing different work tasks at company sites; and 2) a first survey of existing methodologies and their scientific basis. Whereas the latter of these two is still under development, this paper mainly describes results from the specification of requirements formed for RAMP. Figure 1: Examples of work tasks with manual handling at the two participating companies. 4.1 Identified requirements for the RAMP tool The following requirements have been set for the RAMP tool: The tool needs to support communication of the results to different stakeholders. This means that the results summary has to be presented in a way that is easy to read and understand. The tool has to be easy to use and be user-friendly. This aspect is of more importance than the time frame to conduct the risk assessment. The tool should support proactive work in guiding the direction of improvements of the work environment or offer a proposal of improvements. The web-based tool should include a paper form for note taking and as an alternative to computerized collection of in-data. The tool must be applicable for risk assessment for non-routinized work tasks and jobs. In this context this means tasks without a specified work cycle time. 257

254 4.2 Risk factors important to be assessable The R&D team has also agreed that it is desirable that the RAMP tool can assess the following risk factors: Awkward working postures and static working postures Awkward working and manual handling Work above shoulder height and below knee height Heavy manual handling (single lifting tasks) Repetitive work Push- and pull work tasks Hand grip, pushing forces (hand), and hand and thumb postures Frequency and duration Worsening factors such as stress, cold, shift-work In addition, other factors are also being considered for inclusion in the tool. These include different types of handgrips (for example force grip and precision grip), vibration, possibilities for recovery and the duration and frequency of recovery required, and psychosocial factors such as job strain and perceived stress. 4.3 Design of a two-level tool The RAMP will be developed as a tool which can be used at two different levels of analysis: RAMP- I-Level and RAMP- II-Level: The RAMP-I-Level enables a screening of a work station or work task, based on a check list. It is easy and quick to use. This checklist gives a rough analysis and will not require expert knowledge in ergonomics. On the flip side it will not provide any detailed guidance on how to improve the working environment. The results will indicate the presence of certain risk factors. If these are present, a short description of the risk factors is given as well as suggestions on how these can be generally lowered. Also, if the risk factors are present, a more advanced analysis with the RAMP-II- Level tool is recommended. The RAMP-II-Level enables a more detailed analysis. This requires sufficient knowledge in the field of ergonomics. The assessment will result in a description of the risk level, for example if the risk level is acceptable or not, or if an even more advanced analysis is needed to adequately assess the risk of developing a WMSD. The analysis should also be of use when prioritizing between actions to be taken for different workstations or work tasks. For the time being, we aim at giving the user the option to choose which body parts should be analyzed. Risk factors that are considered to be included in the RAMP-II-Level include work with repetitive and stereotypical movements, also at low load levels; work that requires high precision in the movements, for example picking a piece and place it with high precision at a given place; lack of relaxation or pause during a long time period; work that requires awkward postures, for example twisted or flexed postures; work with restricted possibilities for movement and work with a high working pace. 258

255 4.4 Limitations of the RAMP tool The tool will be designed for analysis of standing work (non-seated work). Further, the tool will be based on existing research results on relations between risk factors and MSDs. This implies that risk factors with weak proven relationships may only be included as worsening factors. However, to derive a usable tool qualified assumptions may be made, without strong epidemiological evidence. 5. Discussion and conclusion There are many difficulties when developing models of this kind. One issue that has been discussed within the R&D team and in the reference group is how factors that are considered crucial should be combined when the scientific basis for their combined effects are not well understood. A second issue is how various purposes are prioritised, such as i) the usability, ii) reliability and validity of the tool, iii) company demands for regulatory compliance and iv) regulatory requirements, which are not always scientifically based. Automation increases, but still manual handling is frequent in many companies. Environmental requirements, customer demands regarding products and packaging, et cetera have a strong impact on a company's activities. This may lead to rapid changes of machines and work- tasks to meet the demands. At times automated machines are replaced with machines that require manual handling since machine suppliers cannot keep up with the change process. The suppliers also often lack the knowledge of human factors and ergonomics meaning these considerations are not included in the machine design. Further, manufacturing companies often cannot put demands on the design of machines, usually due to the need for a speedy delivery, however sometimes it is due to lack of knowledge in the field of ergonomics or lack of suitable assessment tools. This then can lead to ergonomic shortcomings which will be fixed subsequently when problems occur. This has negative effects both for the individuals, who suffer pain and have an increased risk of injury, and for the companies who have lesser room for redesign and at higher costs. An easy-to-use risk management method which promotes systematic analysis and supports development of action plans would be beneficial for companies and their employees. The organization of OSH within companies differs quite substantially between companies. Today both Arla Foods and Scania work proactively to reduce WMSDs by using observation based risk assessment tools. To cover the difference in work tasks within the companies, both use a range of different risk assessment tools. Scania has an in-house occupational safety and health organization which supports especially ergonomic-trained operators to conduct risk assessments by using their in-house risk assessment tool (SES). They also conduct risk assessments on their own with SES or other risk assessment tools like KIM (Key Indicator Method). Arla Foods, on the other hand, works with different external OSH companies who conduct the risk assessments. These OSH companies do not have the role to support operators to conduct their own risk assessment. Thus the organization to support ergonomic analyses and OSH improvements differs substantially between different companies and can also differ substantially within the same company. In addition, within large companies, especially active on the global market with activities in many countries, cultural 259

256 and legislation differences play a role in how the OSH work is completed. Both the two large companies participating in this project have highlighted the need for a consistent, systematic risk assessment tool that can be used within their companies, worldwide. Small and medium sized companies often have lesser OSH resources than large companies. Lack of ergonomics competence and a potentially restricted possibility to invest in costly methodology may be a significant hindrance for improving the working conditions in such enterprises. This emphasizes the need for a freely accessible and user-friendly risk management tool. The proposed tool design, with two levels whereof one can be used without expert knowledge, provides the possibility to make in house risk assessments using employees with less ergonomics experience. This would facilitate smaller companies without the financial capital for more expensive tools or dedicated ergonomic resources to complete basic ergonomic assessments. It is concluded that there is a need for, and the possibility to develop, a new risk management tool for manual handling. 7. Future work The next major step in the project is to develop a first version of the model and test it at selected locations within the participating companies. A more thorough model and tool development will be followed by testing, implementation and evaluation of the tool. The project status will also be reported at the next NES conference, NES2012. References Afa Försäkring (2008) (In Swedish) Allvarliga arbetsskador och långvarig sjukfrånvaro. Eklund, J, Lindbeck, L, Riquelme, P, Törnström, L (2007) (In Swedish)Arbetsmiljöarbete med företagsbaserade modeller effekter av belastningsergonomiska insatser. Arbetslivsrapport 2007:17, ISSN , Arbetslivsinstitutet. Falck, A-C (2009) Ergonomics Methods and Work Procedures in Car Manufacturingf for Improvement of Quality, Productivity and Health at Work. Doktorsavhandling, Chalmers tekniska högskola, Ny serie nr Personal communication (2009) with Ruth Carlsson, the Swedish Work Environment Authority. Regerinsgkansliet (2008) (In Swedish) Arbetsmarknadsdepartementet Arbetsmiljön och utanförskapet en tankeram för den framtida arbetsmiljöpolitiken Ds 2008:16. Törnström, L (2007) (In Swedish) Beständig förbättring? - om en företagsutvecklad belastningsergonomisk modell. Licentiatavhandling, Linköpings universitet. LiU-Tek-Lic-2007:33. Svensson, L (2002). Bakgrund och utgångspunkter (In Swedish) In: Svensson, L, Brulin, G, Ellström, P E & Widegren, Ö (eds.). Interaktiv forskning för utveckling av teori och praktik. Arbetsliv i omvandling 2002:7. Stockholm: Arbetslivsinstitutet. 260

257 WHOLE-BODY VIBRATION, POSTURAL LOAD AND WORKING TIME DURING DRIVING AGRICULTURAL VEHICLES Tuure V-M. 1, Lätti M. 1 1 TTS Work Efficiency Institute, P.O. Box 5, FI Rajamäki, Finland The increasing number of working hours by using vehicles, unvaried work load and vibrations are important risk factors and challenges for occupational health services in agriculture during the next years. The aim of the ongoing study was to find out physical work load caused by working postures and whole body vibration during driving various types of agricultural vehicles. The data was gathered on six farms. In this paper the focus is on working postures and whole body vibration during field operations carried out by farm tractors and combine harvesters. Keywords: Whole body vibration, Working postures, Driving, Time 1 Introduction More and more agricultural work is done by driving. Besides tractors also other vehicles, like loaders, mini-loaders and ATVs, have become common on farms. The acquisition of a new type of vehicle has typically not decreased working hours with tractors. Thus, the increasing number of working hours by using vehicles, unvaried work load and vibrations are important risk factors and challenges for occupational health services in agriculture during the next years. Back disorders have become more common among farmers during the last few decades. Almost two thirds of farmers have had back disorders during previous 12 months before an interview (Rissanen 2006). In tractor driving the rotation of the back commonly exceeds the normal area of operation (Bodén et al. 1994). This occurs especially when the driver has to observe the performance or functioning of the equipment attached behind the tractor. The normal extent of the neck (cervical spine) rotation is 45 and the back rotation 40 (Hervonen 1987). In addition to bad working postures exposure of whole body vibration is another stress factor that is strongly associated with back disorders (Ashby and Parker 2004). The typical range of vibration values for common farm tractors on the EU market is m/s 2 (Griffin et al. 2008). These commonly exceed a daily exposure action value of 0.5 m/s 2 and occasionally a daily exposure limit value of 1.15 m/s 2, too. 2 Objectives The aim of the study was to find out physical work load caused by working postures and whole body vibration during driving various types of agricultural vehicles. Also the numbers of working hours with various vehicles on farms are determined. Another aim was to gather technical solutions and advisable driving techniques to decrease the physical work load for choosing and using farm vehicles. The study began in summer 2010 and will be continued till the autumn In this paper the focus is on working postures and whole body vibration during silage and crop harvesting operations carried out by farm tractors and combine harvesters. The study is financed by the Farmers' Social Insurance Institution Mela. 261

258 3 Methods The data was gathered on six farms, three of which were cattle farms and three crop farms (Figure 1). The farms were middle-size or large farms with versatile machinery. Working postures were determined and the level of whole body vibration measured during the most essential tasks on each farm. Small-sized GPS data logger (Ventus G730) was used to record driving speed and distance. Total amount of working hours and the amount of machine work on each farm are calculated by using TTS-Manager programme (Kaila and Tuure 2005) based on standard times in agriculture. Results are presented by work and type of vehicle. Figure 1. Work load factors when using tractors and implements as well as and combine harvesters were studied during normal work on six farms. 3.1 Whole body vibration Whole body vibration was measured by the wireless HealthVib WBW measurement system. The measuring unit was on a seat and the receiver (stores 1 s rms values) in the front of the driver. The system presents the vibration dose and the dominating direction of vibration by the measuring period. 3.2 Working postures In order to analyse working postures video and still cameras were used. Twisted and bent postures of back and head are determined and evaluated according to OWAS method (Salonen and Heinsalmi 1979). It is a method for the evaluation of postural load during work. The OWAS method categorizes postures of four major body segments: trunk, arms, legs, and head/neck. In this study only postures of head and neck are analyzed. 3.3 Working time TTS-Manager labour time planning tool assists to compare the work time requirements between different working methods, machinery and automation alternatives. It can also be used to determine working time of various field machines. The tool takes account production line, farm size, various farm variables, and uses standard times for agricultural work with different machinery and working methods. 4 Results Working postures were poorest during harvesting with a forageharvester and during baling with a round baler (Table 1). Because of the high share of twisted back postures, the load should be decreased as soon as possible (>50 %: action category 3) during these operations. Also the twisted postures of head were common (30 80 %: action category 2; measures needed in the near future) during harvesting and baling. The share of twisted back postures corresponded the action category 2 (20 50 %) also during mowing as well as silage and crop transportation, and the share of twisted head postures during pressing silage and crop harvesting with a wide combine harvester. 262

259 Crop harvesting Tractor Combine harvester Silage harvesting Tractor In silage and crop harvesting (Table 1) the mean value of whole body vibration exceeded the action value 0.5 m/s 2 during transportation along a sand road, during grass mowing and during silage pressing on a silo. Vibration was strongest during transportation and mowing, during which the mean driving speed was 9.0 km/h and over. The dominant vibration axis during crop harvesting with a combine harvester was the vertical axis (Z). By an activate seat with a position sensor and accelerometers 90 % of the vertical movements can be dampened (Hermans et al. 2009). However, during most field operations with a tractor the dominant axis was the crosswise one (Y). During transportation and during silage pressing the longitudinal axis (X) was dominant. So, emphasis should not only go to vertical vibration damping of the chair and the cab. Table 1. Vehicles used in the study, driving speed, whole body vibration (WBV) and working postures during various operations in silage and crop harvesting. The action value for WBV is 0.5 m/s 2. If the share of twisted back postures exceeds 20 %, measures are needed in the near future (action category 2), if 50 %, as soon as possible (action category 3). Mass Speed Whole body vibration Twisted (>20 ) postures Work, vehicle, operation Make, Type Model kg km/h m/s 2 Dominant axis Back, % Head, % Mowing Valtra C Y Forageharvesting Valtra Y Transportation - sand road New Holland TS X Pressing on the silo Valtra C X Harvesting Sampo Rosenlew Z Harvesting New Holland TC Z Harvesting Claas Lexion Z Transportation - sand road Valtra X Transportation - field/field road Valtra N X Baling - round baler (straw) Valtra T Y According to one example of working time calculation silage harvesting (53 ha) takes annually 255 hours tractor work on a dairy farm with 55 milking cows and hectares of arable land. The total amount of tractor work hours is 683 h/year, and the combine harvester is used 59 h/year (crop area 57 ha) on the same farm. 5 Discussion Being exposed to whole body vibration while sitting in a twisted posture increases the risk of back injury; the risk will be increased when a person is exposed to these two factors at the same time. According to this study combinations of the whole body vibration and poor back postures were the most harmful during baling, forageharvesting, mowing and transportation by a tractor. According to HSE (2009) in all of these agricultural tasks whole body vibration is a likely cause of back pain. This means that changes to working practices are needed in order to reduce exposure. In addition it is possible that the time how long the driver spends doing the task needs to be limited. There are several ways to reduce the postural load. Working postures can be improved by improving the ergonomics of cabin. Seat and controls should be adjustable and these features should also be used. A front linkage makes it possible to hitch implements in the front of the tractor. With reverse drive controls the tractor can easily be driven backwards. With mirrors and especially with cameras and monitors twisted postures can be reduced. 263

260 With the suspension of axles, the cabin and the seat the whole body vibration can be decreased. The seat suspension should also be adjusted according to the driver and work. Twin mounted wheels, broad tyre profile and reduced tyre pressure decrease vibration, too. The driver can reduce vibration by proactive driving and by setting down the speed especially on shape surfaces. Maintenance of roads, machines and implements should also be remembered. Driving time can be decreased with efficient machinery or by decreasing the number of driving operations (combining operations). With job rotation driving time can be shared for several persons. Unoccupied machines release the farmer from driving. 6 References Ashby, L. & Parker, R Farm tractors: whole body vibration reducing the risk of musculoskeletal conditions. Centre for Human Factors and Ergonomics (COHFE), Brief Report 2. Bodén, A., Hansson, P-A. & Öberg, K Biomechanical load during tractor driving. In: NJF Teknikk 94, Seminar 251, 1994 November 7-9, Kolbotn, Norge Griffin, M.J., Howarth, H.V.C., Pitts, P.M., Fischer, S., Kaulbars, U., Donati, P.M. & Bereton, P.F Guide to good practice on whole-body vibration. Non-binding guide to good practice with a view to implementation of Directive 2002/44/EC on the minimum health and safety requirements regarding the exposure of workers to the risk arising from physical agnts (vibrations). 65 pp. Hermans, V., Motmans, R., O Neill, D., Roman, D., Lundqvist, P., Pinzke, S., Tokarski, T. & Luycx, A Tractor driving. Good practices in agriculture: social partners participation in the prevention of musculoskeletal disorders. 19 pp. Hervonen, A Tuki- ja liikuntaelimistön anatomia. 3. painos. Lääketieteellinen oppimateriaalikustantamo Oy, Tampere, Finland. 384 pp. HSE (Health and Safety Executive) Whole-body vibration in agriculture. Agriculture Information Sheet pp. Kaila, E. & Tuure, V-M Planning tool for the labour time budgeting on farms. In: Krause, M. (ed.), Proceedings of XXXI CIOSTA CIGR V Congress Increasing Work Efficiency in Agriculture, Horticulture and Forestry, 2005 September 19 21, Hohenheim, Germany: University of Hohenheim, Rissanen, P. (ed.) Työterveys ja maatalous Suomessa Maatalousympäristön terveydelliset riskit ja niihin vaikuttaminen. Työterveyslaitos, Kuopio. Finland. 101 pp. Salonen, A. & Heinsalmi, P OWAS työasentojen havainnointijärjestelmä. Suomen itsenäisyyden juhlavuoden 1969 rahasto, Sarja B: 50, Helsinki, Finland. 151 pp. 264

261 METHODOLOGY TO COMPARE PHYSICAL ERGONOMIC OF HEAVY HAND TOOLS A CASE STUDY ON POWER-CUTTERS Osvalder, Anna-Lisa och Bligård, Lars-Ola Chalmers University of Technology 1. Introduction Despite the increased level of automation of machines there is still work that needs to be performed manually using heavy hand tools. One example of heavy, cumbersome and exhausting work is cutting concrete with hand-held power cutters. Power cutting includes work both in horizontal and vertical directions, with arms and hands above shoulder level or far away from the body, with a flexed and rotated head and back. When cutting at ground level, the work is performed in a forward flexed position with straight legs, resulting in high strengths on the lumbar spine. The work is stressful in the long run and includes discomfort, fatigue and pain. In the worst case this can lead to permanent injuries in muscles, joints and ligaments. When using handheld power cutters, it is almost impossible to perform work tasks with low muscular strengths in favourable body postures. However, a carefully considered design of the machine can result in easy handling as well as safe and efficient operation. 2. Objective The objective of this paper is present a procedure to evaluate physical ergonomic aspects of heavy hand tools and then apply it on power-cutters. The aim was to find out differences between power cutters concerning load application and work postures needed, and reasoning on how the design of a power cutter can influence and reduce the force needed to control the machine during work. 3. Method Power-cutters on the market have nearly the same weight, but the design is different when it comes to position of hand grips and centre of gravity. The evaluation was performed on two frequently used power cutters; Husqvarna K750 and Stihl TS420. The main strategy for the evaluation was to compare the two power cutters with guidelines for an optimised power cutter from an ergonomic point of view. Four common work tasks were evaluated; cutting at ground level, horizontal cutting, vertical cutting, and transportation of the machine. Each work task was described by hierarchical task analysis (HTA). The methods used in the evaluation included theoretical expert heuristic evaluation concerning anatomy, anthropometry and biomechanics, as well as guidelines for ergonomic design of hand tools, objective measurements and calculations, and subjective user estimations. 4. Results The following conclusions were drawn from the evaluation: - An optimised power cutter focusing on user ergonomics should minimise the force that the user has to apply to the machine, while increasing machine control and precision - A carefully considered design concerning position of centre of gravity and handles in relation to the working point result in reasonable workloads, easy handling as well as safe and efficient operation - Working with Husqvarna results in more natural and symmetrical working postures, and less strength of the body muscles, especially in the neck-shoulder complex, upper arm and wrist. This is due to the design of Husqvarna; i.e. the position of the rear and front handles and the centre of gravity in relation to the working point. When transporting the machine, Husqvarna can be carried closer to the body resulting in lower asymmetrical loadings and increased comfort. 5. Conclusion By using a procedure including task analysis, heuristics, measurements, biomechanical calculations and subjective estimations reliable information concerning ergonomics features of a hand-tool is achieved. This 265

262 procedure can be used when comparing different hand-tools on the market as well as in product development. 266

263 USER INTERFACES AT WORK: THE COST OF INCONSISTENCY Kalakoski, Virpi 1, Lukander, Kristian 1, Gröhn, Matti 1, Lukander, Jani 1, Reijula, Jori 1 & Mikkonen, Karri 2 1 Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, Helsinki, Finland 2 Tampere University of Technology virpi.kalakoski(at)ttl.fi The number of parallel interfaces at work has increased. Our objective was to study the effect of consistency of user interfaces on task performance. We developed an objective method to simulate and study multi-interface work situations. Participants reported extra effort if they had to change between different interfaces and recall how the system works. Objective measures showed a significant time cost if the interface for entering the information was inconsistent with the presentation mode. Our findings imply that design principles for systemic consistency are needed to decrease the costs at multi-interface work. Keywords: Multi-interface, Consistency, Task switching, Cognition 1 Introduction Information technology has an increasing role at the work place: in Finland, nearly 75% of employees use computers at work and every third of them spends more than 4 hours of the working day at a computer. In service work, sales, and care work, the use of information technology has doubled during the last 10 years. (Kauppinen et al. 2010) Even though the computer is the main tool to handle tasks in information work, a lot of information processing is also required from the people at work. Using computers requires that we focus attention, classify stimuli, retrieve information from memory and act in an adequate way (Rasmussen 1986). The aim of cognitive ergonomics is to ensure that also the information work with computers is effortless and improves our ability to perform a variety of tasks instead of causing unnecessary load, errors, and waste of time. However, as the number of interfaces at work has increased, also the number of parallel interfaces that one employee is using is increasing. This situation creates a new challenge to cognitive ergonomics: the issue is not only the usability of a single interface at work, but also the usability of a group of interfaces. One aspect of this phenomenon is the systemic consistency between interfaces of different devices used by an employee. People at work are required to use several interfaces that often are inconsistent e.g. in how information is presented and how it should be manipulated. Inconsistency between interfaces decreases the end user convenience at the general, systemic level, however well the individual entities would have been designed from the single device or the service point of view. Therefore, when customer solutions are built, creating systemic value for the customer becomes an important topic to manage. Thus, this research topic is also tightly connected to modern management science. (Mikkonen 2011) 267

264 From the perspective of cognitive psychology and ergonomics, multi-interface work challenges human information processing. Several findings of cognitive psychology suggest that performance may be seriously impaired if interfaces require changing between different tasks and recalling principles that may vary or even be in contrast with each other. The theoretical background for this study comes from research on human information processing concerning our ability to perform when work requires switching attention between tasks, principles, or interfaces. 1.1 Switching between tasks is cognitively demanding Task switching has been studied systematically with several methods since the mid 1990s (Monsel 2003). The basic idea of task-switching experiments is that participants are performing simple tasks, e.g. classifying digits as odd/even or letters as consonants/vowels. In the experimental conditions, the tasks either change from trial to trial, or stay the same for the whole block of trials. The costs of task switching are well demonstrated. General task switching cost or mixing cost, which is relevant to our study, is defined as a difference in performance level between blocks with changing tasks and those with a constant task (Monsel 2003). The magnitude of the task switching cost is affected by several factors, e.g. type of task, but it is substantial in all cases, often being tens of percentages (but see also Chamberland & Tremblay 2011). Why then is performance, even in simple tasks, prone to errors and increase in performance time, when one must switch focus? The literature suggests several processes of human cognition, related to attention, working memory, and long-term memory, that may underlie task switching costs: inhibition of prior tasks-sets, retrieval of stimulus-response rules into working memory, and associative activation of competing tasks-sets in long-term memory (Altmann & Grey 2008; Monsell 2003). The great number of the basic cognitive processes behind task switching costs motivates further studies; task switching and underlying cognitive processes are relevant to a wide variety of tasks that everyone meets at work and in life in general. 2 Objectives We developed an objective method to simulate and study cognitive demands of a typical multi-interface work situation, where people are required to use interfaces that are either consistent or inconsistent in how information is presented to the user and in how she/he is required to input information. Our main question was whether consistency of user interfaces improves task performance. We studied the magnitude of the task switching cost when the interfaces for presenting and entering sequences of digits were either consistent or inconsistent in mode of information. 268

265 3 Methods In the task, numerical information (dates) were presented and had to be entered into another interface. We measured performance time and number of errors in conditions where the presentation mode of information was either consistent or inconsistent with the mode required by the input interface. 3.1 Participants We recruited ten participants (7 male), average age 41 years (25 62 years) who were familiar with using a computer at work. They participated voluntarily and were not paid. 3.2 Task and Material We developed a simple task where participants were briefly presented numerical information on a computer screen. Thereafter, they were asked to enter the previously presented information into the computer, using a numerical keyboard, as fast and errorfree as possible. The information consisted of dates, i.e. year, month, and day. The presentation mode of information was either consistent or inconsistent with the mode required to enter the information. There were three modes for presenting and entering the dates, named according to the first item. In the Year mode, the presented digits referred to year, month, and day, e.g In the Month mode, the presented digits referred to month, day, and year, e.g. 09/19/2011. In the Day mode, the digits referred to day, month and year, e.g In the three different modes, the Year, the Month and the Day, the symbols between the digits were different, as seen in the example above:, /, and., respectively. Thus, the visual consistency and detail did not vary significantly between the three presentation and entering modes, but every mode had 8 digits and simple symbols between them. In each trial of the task, the date was shown for 3000 ms, followed by the screen with 8 empty spaces in which to enter the date by tapping the numbers in the correct order on a computer keyboard (numeric keypad on the right side). The symbols between empty spaces indicated in which format the information was to be entered: for the Year mode, for the Month mode / /, and for the Day mode... (see Figure 1) Fi gu re 1. A n ex a mple of the Day presentation mode shown to the participant on the screen (left), and the same information when it was being entered to the computer in the Year mode (right). Note that in the task only one of these screens was visible at a time. 3.3 Study Design The degree of consistency of information between presentation and entering was varied systematically. For group number 1 (4 participants), the consistent condition included a 269

266 constant presentation mode (Day mode), and the same entering mode. For group number 2 (6 participants), all consistent conditions were included (i.e. Day-Day, Month- Month, Year-Year). For both of the groups, in the inconsistent condition the presentation mode was kept constant (Day), and the entering mode varied. For group number 1, there were 25 practice trials. The experiment included a Consistent condition (Day-Day presentation-entering pairs) consisting of a block of 10 trials. There was an Inconsistent condition consisting two blocks of 10 trials (Day-Year and Day- Month presentation-entering pairs), and an Inconsistent-Mixed condition with one block of 30 trials in which Day-Day, Day-Month and Day-Year presentation-entering pairs varied pseudo-randomly. All of these blocks were repeated 3 times with new stimuli and in a different block order, resulting in 180 trials together. For group number 2, there were 18 practice trials. The Consistent condition included three blocks of 20 trials for Day-Day, Month-Month, and Year-Year presentationentering pairs. The Inconsistent-Mixed condition was similar as for group number 1, but it consisted of a block of 60 trials. Thus, there were altogether 120 trials for group number 2. Each participant was individually tested and the session also included other conditions, following the ones described here, but they are not reported in this context. At the end of the session, the participants were interviewed about their subjective thoughts about the task and the conditions. The whole session, including instructions and tasks, took minutes per participant. 4 Results and Discussion From the interviews we collected the subjective comments concerning the task and the conditions. As objective measures we studied the percentage of correctly entered dates and the time to enter the correct dates. Task switching costs were computed as general switch cost by comparing the total times when conducting all tasks (trials) in one block: Consistent, Inconsistent or Inconsistent-Mixed. 4.1 Subjective comments Our participants reported in the interviews that the multi-interface task successfully simulates typical workplace situations. They reported that conducting the laboratory task was like using inconsistent interfaces at work: their subjective feeling was that it took a lot of effort to change between different interfaces and tasks, and to recall how the system works. These opinions suggest that we succeeded in developing a task that is simple, but simulates the cognitive functions needed when people switch between interfaces. Since the task does not require specific skills or knowledge, it can be used for various employee groups regardless of education and experience. 270

267 4.2 The effect of consistency Percentage of correctly entered dates and task switching costs are presented in Table 1. The results suggest minor effects of systemic inconsistency on error percentages in the multi-interface task. Depending on the specific condition, on average % of the entered information was correct. When comparing blocks of trials with consistent and inconsistent information presentation and entering modes, the variation in performance level was negligible; at most 4 %. Table 1. Performance level and task-switching cost in three experimental conditions: Consistent blocks, Inconsistent blocks and Mixed inconsistent blocks. The variable Percentage of extra time needed used the consistent block(s) as a baseline. Variable Correct entering 82 % 78 % Consistent (D-D) vs. Inconsistent (D-M or D-Y) Consistent (D-D) vs. Inconsistent-Mixed (D-D, D-Y, D-M) 82 % 79 % Consistent (D-D or M-M or Y-Y) vs. Inconsistent-Mixed 72 % 72 % Extra time needed 21 % 11 % 9 % However, the time to complete one block of tasks was affected by the consistency of the tasks in that block. More time was needed to perform a block if the interface for entering the information was inconsistent with the presentation mode. If consistent blocks with the same presentation and entering mode were taken as a baseline, 9-21% more time was required if the blocks included tasks where presentation and entering modes were inconsistent. In an occupational context, this amount of wasted working time would cause a meaningful extra cost for the organisation. These results show that this method enables the objective measurement of the cognitive costs of inconsistent interfaces. Objective measures, like the one used here, offer concrete numbers that describe what happens to performance level (errors and performance time) in certain conditions. In this case, the task switching cost is substantial in all conditions. It is also important to note that the individual variability in performance was large, but the effect of task switching was present in the performance of each participant. The results indicate that task switching cost is a relevant and crucial factor also in applied settings, such as in multi-interface work situations. 4.3 The effect of mode of information The magnitude of the consistency effect is partly explainable by the specific mode of presenting and entering information. Information mode affected the time required to enter information in the computer (correct trials). The results showed that participants of the present study required more time if information had to be entered in the Year mode, e.g , instead of other modes (Figure 2). This is also shown in the entry times when presentation and entering are both in the same Year mode. The difficulty of the Year mode for our Finnish participants is also shown in the percentages of correct responses in the three different blocks of consistent tasks: 63%, 73% and 78 % for the Year-Year, Month-Month and Day-Day blocks, respectively. These results show that although the task-switching cost is evident, its magnitude depends on the specific task at hand. According to our results it is related to the difficulty of the basic tasks and information modes. This result may reflect the familiarity of the task at hand, the memory load it causes and the learnability of the task. 271

268 Mean Entry time (ms) DD DM DY MIXED DD MM YY MIXED Group 1 Group 2 Block conditions Figure 2. Mean entry times (correct trials) for Consistent (DD, MM, YY), Inconsistent (DM, DY) and Inconsistent- Mixed blocks. D: day, M: month, Y: year. First character: presentation mode, Second character: entering mode. e.g. DM: Day mode in presentation and Month mode in entering. 5 Conclusions In this study, we showed that it is feasible to study and simulate with a simple task how systemic inconsistency impairs task performance, and thus apply the objective methods and findings of cognitive psychology in an occupational context. The results show that using multi-interfaces is prone to substantial task-switching costs. Our approach offers a way to estimate the magnitude of costs if employees are required to use inconsistent interfaces at work. Future studies are needed on a larger variety of tasks, and the results of objective performance level measurements should be combined with information on work specific details, such as the total duration of similar tasks in a typical day. Together these kinds of data would enable the estimation of the true costs and savings at the organisational level when specific interfaces, systems, and cognitive ergonomics practices are in use. This will enable more accurate design of complex customer solutions, adding general, systemic level convenience to the end user. 6 References Altmann, E. M. & Gray, W. D An Integrated Model of Cognitive Control in Task Switching. Psychological Review, 115, Kauppinen, T., Hanhela, R., Kandolin, I., Karjalainen, A., Kasvio, A., Perkiö-Mäkelä, M., Priha, E., Toikkanen, J. & Viluksela, M Työ ja terveys Suomessa Helsinki: Työterveyslaitos. Mikkonen, K Exploring the Systemic Value for Customer in Integrated ICT Offerings. Doctoral Thesis. Publication 966. Tampere University of Technology. Monsel, S Task Switching. Trends in Cognitive Sciences, 7, Rasmussen, J Information Processing and Human-Machine Interaction: An Approach to Cognitive Engineering. NY: Elsevier. Chamberland, C. & Tremblay, S Task Switching and Serial Memory: Looking into the Nature of Switches and Tasks. Acta Psychologica, 136,

269 C3: VISUAL ERGONOMICS C3.1 Ergonomic assessment of interiors of residential dwellings through visual system Promila Sharma C3.2 The effect of glare on reading eye movements Susanne Glimne 273

270 ERGONOMIC ASSESSMENT OF INTERIORS IN RESIDENTIAL DWELLING THROUGH VISUAL SYSTEM DR.SHALINI AGARWAL and DR. PROMILA SHARMA DEPARTMENT OF FAMILY RESOURCE MANAGEMENT COLLEGE OF HOME SCCIENCE G.B.P.U.A & T, PANTNAGAR ABSTRACT Residential dwelling must fulfill the needs for the daily activities of the residents, and it must give them satisfaction, security, comfort, and independence. Exploratory cum Experimental research design was chosen for collecting data. Purposive cum Random sampling design was used to select the study area and to select residential unit, systematic random sampling was adopted. Most of the respondents had the opinion that there is high association between visual task performance and elements of art. In most of the residential dwellings, infrastructural facilities were lacking and if available they were not as per the requirement of the residents. Respondents of different residential areas were found suffering from eye problem, diabetes, hyper tension and joint problems. Most of the colours symbolized positive characteristics except black which symbolized negative characteristics. To study the relation between knowledge of respondents about elements of art and residential area as well as to find opinion of respondents regarding elements of art and visual task performance, f-value in both the cases was found partially significant. A soft-ware, plus booklet was developed which provides information about use of different elements of art in the interior/ exteriors of the house taking into consideration principles of visual ergonomics to reduce hazard at the place of work and increase work efficiency. The findings of the investigation brought out a number of implications for the users, builders and interior decorators. Ergonomically designed interiors will create a much more comfortable and healthy environment and enhance task performance. Key words: ergonomics, residential dwelling, visual system Introduction A residential dwelling should be planned, furnished and built in such a way that it accommodates in best manner all the activities besides being simple, comfortable and interesting rather than ornate or disruptive. Residential dwelling must fulfils the needs for the daily activities of the residents, and more precisely it must give them: satisfaction, security, comfort, and independence or at least one of them. Interior space planning together with the design of color, finish, and lighting treatments must support the day-to-day activities of building users. It leads to psychological satisfaction, which is related to interior environment and interior have impact on task performance. Visual ergonomics is the investigation of human physical characteristics and limitations with respect to the environment as related to visual communications. Visual ergonomics is concerned with the combination of finish color, finish texture and material, and lighting produces the visual environment within a space. It is critical that room finishes and lighting be coordinated to provide adequate seeing conditions for the activities to be conducted in the space. 274

271 Many of our oldest and wisest sayings are related to eyes. That s probably because vision is our primary connection with the world.the process of vision begins with visible light a portion of the radiation spectrum that stimulates the nerve endings in the retina. Illumination is important to humans because it alters stimuli to the visual system and the operating state of the visual system itself. Interior lighting is almost always sufficient for the visual system to be operating in the photonic region. Differences between persons in visual capabilities are common and are usually dealt with by providing lighting that is more than adequate for visual performance and visual comfort. The visual sense is the most important channel of information in information- intensive work. From the point of view of seeing and eye fatigue, the ordinary visual displays are not the most optimal solutions. Interiors of rooms have various visual effects on humans. Color, form, space and light are the principal interactive ingredients of the architectural environment, but color is the one element that most affects the others. The most obvious and basic requirement in the dwelling is lighting as it permits vision to perform different activities. Home is a place to relax and to carry necessary household work and other activities. Lighting in the dwelling should provide certain emotional and aesthetic satisfaction. Poor lighting has been associated with a variety of problems including low productivity, high human error rates, eyestrain, head-ache, reduction in mental alertness, general malaise, and low employee morale. A line is the beginning point for designing, because it establishes shape or form and is a valuable element of composition. In interior designing, straight lines are considered intellectual rather than emotional, classic rather than romantic and sometimes severe and masculine. Curves, on the other hand, are used to achieve a more joyful, subtle and rich effect. Texture is most often used to describe the relative smoothness and roughness of a surface. Texture expresses the artist s meaning and accentuate the impact created. Designers tap the potential of the textural qualities of building materials. As human being spends most of his time in his dwelling thus functional and comfortable dwelling along with different elements (proper entry of light, colour, line and texture) in the interiors is must for his health as well as to increase working productivity. Objectives of the study: 1.To study the family profile of the respondents. 1. To study the existing structure and lighting system of the residential dwelling. 2. Application of Visual ergonomics to the elements of design. A] To study the functional characteristics of light and its impact. B] To study colour vision and preference. C] To study visual search and effect of texture, design and line in the interiors. 4. To study the physical and psychological cost of work in terms of visual performance, task performance and productivity. 5. To study the symptoms and causes of visual discomfort. 6. To develop approaches to improve performance and visual comfort. Material and methods Exploratory cum Experimental research design was chosen for collecting data. The present study was carried out in district Udham Singh nagar. Purposive cum Random sampling design was used to select the study area and to select residential unit, systematic random sampling was adopted. Total sample size was 120 residential units, 40 each from three different selected residential colonies (partially self build, fully self build and build by builder). 275

272 Pre-coded personal interview schedule was constructed to gather general information about respondents and residential dwellings. Checklist was used to collect in-depth information about the residential dwelling. Three point scales were developed to collect knowledge and opinion of respondents on different aspects of elements of art. Test was developed to collect information on psychological effects of different elements of art. Experimental tables were constructed to record data related to eye fatigue and visual task performance in different lighting conditions. Various equipments were used for collecting the data and these included anthropometric kit, polar heart rate monitor sphygmomanometer, eye head tracker, lux meter, stopwatch and vision testing equipment for experimental data. The data was collected in two phases, in phase first, descriptive data was collected and in second experimental data was collected. In the present study frequency, percentage, mean, standard deviation were used to analyze descriptive data. Analysis of variance and chi-square were used for testing hypothesis. Result and discussion Maximum selected respondents both male and female were between years age group. As far as educational qualification was concerned, it was found that most of the respondent were highly qualified, that is nearly 37.0 per cent female and 45.0 per cent male respondents were post graduate. Nuclear type family system was predominant (73.3 per cent) most of the male respondents (98.3 per cent) were employed whereas only 41.6 per cent female respondents were working. It was found that 26.6 per cent female and 40.0 per cent male respondents were possessive private jobs. Forty per cent were having their total monthly income ranging from Rs /-. Nearly 81.7 per cent respondents were having their own residence and 70.8 per cent were having single storied dwelling while 29.2 per cent had double storied dwelling. It was found that 36.7 per cent respondents had their residence facing towards east while most of the respondents (81.7 per cent) had open area in their residential dwelling in which 51.7 per cent had open area on two sides of their residence. Lighting facility in different rooms showed that 39.2 per cent respondents had more than two light sources in their living room. Whereas 61.7 per cent respondents were having two types of light sources in bedroom and in dining room most of the respondents (70.0 per cent) had only one type of light source. Similarly, in kitchen and bath / w.c., most of the respondents (65.8 percent & 75.8 percent) respectively had only one type of light source. It was found that in store room all the respondents were having only one type o light source. Results also revealed that nearly, 35.8 per cent respondents were having three different light sources (fluorescent straight light, incandescent filament bulb and CFL) in their living room, where as in bed room, combination of incandescent filament bulb and CFL was used by most of respondents. In dining room most of the respondents used either CFL or fluorescent straight light while in kitchen CFL was by 29.2 per cent respondents. In store room 45.0 per cent used incandescent filament bulb. In bath / w.c. also, incandescent filament bulb were used by majority of respondents. Data revealed that major health problems faced by the respondent were eye problem (35.8 per cent), diabetes (30.0 per cent), hypertension (28.4 per cent) and joint problem (25.0 per cent). Very few respondents complained of either pain or stiffness in any body part. When asked about eye related discomfort, results showed that nearly 20.0 per cent respondents complained of pain in eyes and of eye fatigue respectively. About 15.8 per cent respondents complained of redness in eyes while 13.3 percent told about irritation in eyes as well as blurred vision. Only 15.0 per cent stated heredity reasons for eye related discomfort and rest stated other reasons like working in low light, improper lighting facility at work places, insufficient natural lighting, etc. Results revealed that 64.2 per cent respondents had fair knowledge about elements of art, where as 20.0 per cent had good knowledge and only 15.8 per cent had poor knowledge about the same. 276

273 It was also found that about 44.1 per cent respondents felt that there is high association between visual task performance and elements of art, where as 30.8 percent felt that there is fair association while 25.0 per cent felt there is poor association between visual task performance and elements of art. When infrastructural facilities in different rooms were studied, results revealed that most of the infrastructural facilities were lacking in all the rooms and those available, they were not as per requirement of family members though height of doors and windows was suitable for family members. The width of doors and windows was sufficient for ventilation and natural lighting in most of the rooms especially in living room, bed room, dining room and kitchen. Results also depicts that the colour of wall as pleasant for all family members and the floor was non-slippery in all the rooms. When choice of colour on walls of different rooms were studied by showing shade card of nerolac paints, results revealed that 66.6 per cent respondents preferred Lafleur, followed by 62.5 per cent respondents selecting After Glow. None of the respondents preferred white smoke colour in their living room, the reason for their preference may be to make their living room lively and bright. In bed room most of the respondents (70.8 per cent) preferred Belinda colour where as 66.6 per cent respondents preferred Cool pool, Green Grape and Zesty Lilac. In this room also none of the respondents liked using White Smoke colour. The reason for selecting such colours may be, because, these colours are cool in nature and may be relaxing. In dining room, about 45.8 per cent respondents liked to use Green grape and Marble Mist. In kitchen, more than half of the respondents (55.0 per cent) preferred Green grape. It was also found that bright colours were avoided in kitchen. The reason may be because bright colours absorbs light and in kitchen good amount of illumination is required. In store room, majority of the respondents preferred shades of white, like Marble Mist and in bath room, most of the respondents (79.1 per cent) preferred Marble Mist where as few respondents (12.5 per cent, 11.6 percent) preferred White Smoke and Green Grape respectively. When preference for designs on walls and ceiling were studied, results revealed that majority of respondents (70.8 per cent) preferred designs on alternate walls, whereas 53.0 per cent preferred designs on adjacent walls. It was also seen that more than fifty percent (54.0 per cent) respondents preferred designs on ceiling and only 37.5 per cent respondents liked to have designs on ceiling. A test was developed to study the psychological effect of colour, line and texture on individuals. Results of the test showed that for 40.0 per cent respondents, yellow colour was the symbol of gaiety, while red colour was the symbol of love for nearly half of the respondents. Nearly 40.0 per cent felt that this colour is stimulating while only 10.0 per cent respondents felt that red colour shows aggression also. Nearly 20.0 per cent respondents believed that blue colour denotes honor and happiness whereas, 14.0 per cent respondents felt that this colour also depicts truth. Nearly half of the respondents believed that orange colour symbolize courage whereas 14.0 per cent respondents believed that the colour also depict intellect. Results also showed that for nearly half of the respondents (48.0 per cent), green colour was a symbol of spring and nearly 16.0 per cent felt that the colour represents rest also. Similarly 40.0 per cent respondents felt that purple colour symbolize mobility while 14.0 per cent felt the colour reflects vagueness too. When neutral colours were studied, results revealed that white colour depicts formal effect for 34.0 per cent respondents where as 30.0 per cent symbolize white colour related with clarity but for 10.0 per cent respondents this colour represented something horrible too. Results also depicted that for nearly 42.0 per cent respondents black colour depicted horrible things and for 34.0 per cent respondents it is a symbol of sophistication and darkness. Only 5.0 per cent respondents felt that the colour represented solidity too. Similarly, 38.0 per cent respondents felt that brown colour symbolize boredom, while 14.0 per cent felt, it represents masculine properties. Grey colour represented gentleness for nearly 36.0 per cent respondents. 277

274 When psychological properties of different lines were studied, results revealed that majority of respondents (80.0 per cent) felt that vertical lines produces illusion of height, while 90.0 per cent respondents felt that horizontal lines broaden the shape, majority of respondents (80.0 per cent) felt that zig-zag lines represents activity. About 64.0 per cent respondents felt that diagonal lines represent activeness. Majority of respondents (90.0 per cent) felt that curved lines are smooth where as 70.0 per cent respondents felt that circular lines gives the feeling of compactness. Further the results revealed that majority of respondents (96.0 per cent) felt that smooth textures attracts attention and about 94.0 per cent respondents felt that such textured objects reflects light while, 90.0 per cent respondents felt that rough textures absorbs light and about 58.0 percent felt that they add style too. To access visual stress while performing activities, an experiment was conducted on eyehead tracker in DRDO laboratory, New Delhi. Results of the same revealed that as the intensity of light decreased pupil diameter increased, which may be due to stress on eyes in low intensity light. Similarly, to study relationship between visual task performances under different lighting conditions an experiment was conducted in visual ergonomics lab. in the dept of family resource management, college of home science, G.B.P.U.A.&T., Pantnagar. To study the task performance, parameters like number of mistakes made and time taken to complete the task were studied and results revealed that maximum mistakes were made under incandescent halogen bulb of 60 watt and minimum mistakes were made under incandescent halogen bulb of 100 watt while minimum time was taken under CFL of 14 watt. Physiological parameters like heart rate and blood pressure were studied under different lighting conditions and results showed that increase in heart rate was seen after the activity in each light, but maximum increase was observed under incandescent halogen bulb of 100 watt. Similarly, there was increase in systolic and diastolic blood pressure. Maximum increase in systolic blood pressure was observed under incandescent halogen bulb of 60 watt and CFL of 14 watt. It was also found that chi-square value was found non significant between health problems and residential area as well as eye problems and residential area which depicts that health as well as eyes problems are affected by the residential area. Similarly chi-square value was computed for visual task performance and different lighting conditions was found non significant which depicts that visual task performance was affected by the lighting system used for conducting the activity. Analysis of variance was computed to study the relation between knowledge of respondents about elements of art and residential area as well as to find out opinion of respondents regarding elements of art and visual task performance and f-value in both the cases was found partially significant which suggests that knowledge of respondents is partially affected by the residential area and respondents felt that some elements affect the visual task performance. Conclusion On the basis of findings of this investigation the following conclusions were drawn: Respondents were of the age-group years. Both male and female respondents were literate and most of them were working in private sector. Most of them owned their single storied house. In all three different residential areas, most of the dwellings were east- facing and most of them were having open area on two sides. Lighting facilities in different rooms displayed were recorded and it was found that in living and bed room most of the respondents were using two or three different types of light sources, whereas in kitchen, dining room, store room and bath room one or two different type of light sources were used. To have proper illumination in different rooms two or three different type of light sources were used and combination of fluorescent straight light and compact fluorescent lamp (CFL) was used the most. Tints of primary and secondary colour were preferred on walls of different rooms except in store and bath room where white or 278

275 its nearby colours were preferred. Most of the respondents preferred designs on two alternate walls. Majority of respondents had fair knowledge regarding elements of art. Most of the respondents had the opinion that there is high association between visual task performance and elements of art. In most of the residential dwellings, infrastructural facilities were lacking and if available they were not as per the requirement of the residents. Respondents of different residential area were found suffering from eye problem, diabetes, hyper tension and joint problems. The eye problems may be due to improper lighting facility at different work stations. Most of the colours symbolized positive characteristics except black which symbolized negative characteristics. Different types of lines (vertical, horizontal, zig-zag, diagonal, curved and circular) symbolized movement of eyes and activity. Designs on two walls especially, alternate walls was preferred the most followed by designs on ceiling only. The reason may be designs on all walls may make the room look busy and crowdy. Lighting facility available at work place affects the eye movement like contraction and expansion of pupil diameter, blinking frequency and number of blinks per minute. The visual task performance of individual is affected by the type and source of lights used. Inadequate lights used in a work place also affect the heart rate and blood pressure of the person. In most of the cases, heart rate increases in high intensity light. BIBLIOGRAPHY Anshel J Visual ergonomics in the work place. Visual examination. Taylor and Francis..London Anshel J Visual Ergonomics: Hand Book. CRC. Taylor and Francis. NW. Birren, F Color Psychology and Color Therapy. New Hyde Park: University. Bommel W. J.M.V Non-visual biological effect of lighting and the practical meaning for lighting for work. Applied Ergonomics. 37:

276 THE EFFECT OF GLARE ON READING EYE MOVEMENTS Susanne Glimne, Gustaf Öqvist Seimyr, Rune Brautaset Karolinska Institute, Dept. of Clinical Neuroscience, Unit of Optometry, Stockholm, , Sweden. Corresponding author address: The aim of the study was to investigate how reading eye movements are affected by glare while performing reading on a computer screen. A Tobii eye-tracker T120 was used to record the reading eye movements. A large proportion of computer work is related to reading. Reading eye movement includes saccades, fixations, and regressions. In the reading process, the primary function of a saccade is to bring a new region of text into foveal vision. The time spent processing the text before a new eye movement is made, is called a fixation. Regressions are leftwards eye movements to refixate a word. The presence of degraded foveal image results in increased fixation rate and shorter fixation duration, increased saccade rate with shorter length, and increased regression rate. Glare represents one of the most common sources that can degrade the foveal image. The effect of glare on eye movements while reading on a VDU placed at 60 cm distance from the eyes were measured in 16 subjects between years of age. In addition to the condition of no glare (ceiling luminary, placed above with a luminance of 800 cd/ m 2 ), three controlled conditions of glare were used: (1) direct light from a ceiling luminary in front (luminance of 1250 cd/m 2 at a vertical angle from eyes of 45, at a distance of 135 cm); (2) indirect light from an artificial window behind the screen (luminance of 1850 cd/ m 2 at a distance from participants of 55 cm); and (3) desk luminary at right (luminance of 450 cd/ m 2 at an horizontal angle of 35 from eyes, at a distance of 40 cm). Subjects were asked to do three tasks consecutively: First they read a short (146 words) readability controlled text (International Readings Speed Texts), secondly a longer newspaper text (ca. 800 words), and finally a second IReST text. The tasks were repeated for each of four lighting conditions. The IReST texts were presented left-justified in a 12 point sans-serif font on single page. Reading speed, fixation rates, fixation duration, saccade rates and regression rates were analyzed. For analysis, repeated measure ANOVA was performed on the results of the last short readability controlled texts in all lighting conditions. Based on the analysis, a negative effect on reading eye movements was found with all three conditions of glare as compared to the situation of no glare. The reading speed was slower in all glare conditions, but the difference was not significant. Lighting conditions of direct and indirect glare were considered close to significance. If the value of q was greater than then the P value was less than The value of q for direct glare was and the value of q for indirect glare was Fixation rates per second were lower in all glare conditions with significant differences for direct glare (p<0.01) and indirect glare (p<0.05). Fixation duration was longer in all glare conditions with significant difference for direct glare (p<0.01). Saccade rates per second were lower in all glare conditions with significant differences for direct glare (p<0.05) and indirect glare (p<0.05). A regression rate per second was not significant in difference. The results of this study shows that glare have a negative effect on reading eye movements. This is in line with previous findings which have shown reading to be affected by reduced contrast and degraded foveal image. These findings show that care must be taken when positioning luminaries in a VDU work place, since 280

277 reading eye movements were negatively affected even though all the three conditions in which glare was induced all fell within recommended illuminance levels (SS-EN ). 281

278 D3: PROMOTION OF HEALTH, SAFETY AND WELLBEING AT WORK D3.1 Background and conceptual model for the prevention packages: an initiative to prevent physical and mental wear and tear in small workplaces Laura Kvorning D3.2 Supervisors as tightrope walkers in organizations - a safety net needed? Liisa Mäkelä D3.3 Promoting occupational health safety, and well-being by training line managers Sari Tappura D3.5 Essence of well-being at work: analysis of interviews Henri Jounila 282

279 BACKGROUND AND CONCEPTUAL MODEL FOR THE PREVENTION PACKAGES: AN INITIATIVE TO PREVENT PHYSICAL AND MENTAL WEAR AND TEAR IN SMALL WORKPLACES Kvorning, Laura K. V. MSc 1, Rasmussen, Charlotte D.N MSc 1, Hasle P. MSc. Ph.D 1 1 National Research Centre for the Working Environment Contact: Workplaces in Denmark within specific sectors are offered the opportunity to apply for financial support to implement projects designed to reduce wear and tear in the working life and improve the work environment in the workplace through The Prevention Fund. The grant application process has particularly discouraged small workplaces from applying and as a consequence of this the Prevention Fund has been extended to cover projects called The Prevention Packages. Each package is a predetermined intervention focusing on common work environment problems in sectors in increased risk of physical and mental wear and tear. Keywords: small workplaces, intervention, prevention, health promotion. 1. Introduction It is generally accepted that small workplaces are exposed to occupational hazards and have a higher risk of injuries than larger organisations. Small workplaces often have limited resources to prioritise these risks and improve the work environment. Furthermore it seems that regulation, control and campaigns aiming at improving the work environment in small workplaces have only had limited effect. (Champoux & Brun 2003;Hasle & Limborg 2006) It is well documented that small workplaces have difficulties implementing systematic work environment policies, and that the owner/manager is essential for this implementation. The owner/managers motivation and knowledge about work environment and his/hers understanding of the needs at the workplace plays an important role in relation to the work environment in the workplace. Many owner/ managers do not recognise the link between work environment and improved health and wellbeing of the employees, and therefore work environment is often a matter of satisfying the authorities (Axelsson 2002;Vickers et al. 2005). Some studies seem to suggest that many owner/managers overestimate their knowledge about work environment and underestimate the risks at the workplace (Eakin 1992;Hasle, Kines, & Andersen 2009;MacEachen et al. 2010;Walters 2006). It varies how the owner/managers view work environment, and whether they see it as a positive matter, an economic burden or a restriction of their personal freedom. Their view is also affected if they lack knowledge about work environmental risks and legislation. It was found that two aspects have an impact on the effect of interventions a) small workplaces should be offered concrete and accessible solutions and b) the solutions should be accepted by colleagues and rival companies (Cooke & Wills 1999;Davis, Renzulli, & Aldrich 2006;Hasle et al. 2004;Hoque & Bacon 2006;Ito, Sakai, & Kogi 2006). It is therefore necessary that interventions targeting small workplaces include those instruments most suitable for the workplaces. This could be different kinds of counselling, legislation or regulation, economic incentives, training and dissemination of knowledge or a mix of different instruments. Different initiatives to meet the needs of small workplaces to improve the work environment have been developed. One initiative is the Prevention Packages (PP). This paper presents the background and conceptual model for the PP and the details about the design and context of the PPs is described in the paper by Rasmussen, Kvorning and Hasle (Rasmussen, Kvorning, & Hasle 2011). 283

280 2. The Prevention Fund In Denmark a relatively new instrument has been developed to improve the work environment. The Danish government recognised a need for initiatives targeting specific sectors where employees are at increased risk of physical and mental wear and tear and thereby exclusion from the labour market. As a consequence the government and most of the remaining parties in the parliament entered an agreement establishing The Prevention Fund (PF) in The PF grants up to 350 million DKK annually and the overall objective of the PF is to reduce wear and tear in the work life and exclusion from the labour market. The PF grants financial support to projects within four different categories: 1) projects to prevent wear and tear at work, 2) projects to develop new technologies to prevent routines and work procedures that may lead to wear and tear, 3) projects to improve rehabilitation of sick-listed and disabled persons and 4) projects concerning health promotion where the aim is to raise awareness of the risks connected with smoking, alcohol, obesity and physical inactivity (BM 2007;BM 2009). To apply for a grant the workplaces have to design a project within one of the four categories. All projects are subsequently thoroughly assessed by a professional committee selected by the PF. In order to receive the grants, the workplaces have to evaluate and report the outcome of the project to the PF. This grant application process has particularly discouraged small workplaces from applying. There are many reasons why small workplaces find it difficult to apply for projects in the PF. First, small workplaces lack resources to develop such projects in terms of both time and capability to design a project. Second, small workplaces find it difficult to fill out the application form correctly. Third, small workplaces find it difficult and resource demanding to evaluate and report the outcome of the project to the PF (BM 2011). In order to meet the needs of small workplaces the PF has been extended to cover predefined projects the PPs that can be described as small interventions. The PPs target specific sectors. The sectors have been selected on the basis of national data regarding the number of early retirements, high sickness absence and high frequency of disability retirements among employees in Denmark. Currently sectors are selected as target groups for PPs, e.g. the construction industry, the home care and residential care sector, the auto repair industry, taxi drivers and the cleaning industry. The employees in these sectors are characterised by being unskilled or of short education. It is often a target group, which is difficult to reach with traditional health prevention campaigns, although it is well known that they are at increased risk of physical and mental disabilities, and that the work environment has a great influence on their health and well-being (Didrichsen 2011). Small workplaces within the selected industries were able to apply online from January 2011 (Forebyggelsesfonden 2011). The details about the content of the PPs for the two first sectors Construction industry and Home care and residential care are described elsewhere (Rasmussen, Kvorning, & Hasle 2011). 3. Development of The Prevention Packages 3.1 Conceptual model of The Prevention Packages The PPs are based on evidence-based research within the specific sector. The evidence-based research covers results from intervention studies and research in the specific sectors. Other reports and studies from the sector as well as quantitative and qualitative data from inspections from the Danish Working Environment Authority (WEA) are also included. Additionally, qualitative data from workplace visits and experiences from labour unions and employers associations are included in the development process. On the basis of these sources it is possible to develop PPs that are of high importance to workplaces in the sector. Thus, the projects address the most common work environment problems in the sector, and the methods used are selected in consideration of the needs and characteristics of the sector. 284

281 The PPs are small interventions consisting of a project description and a budget. It encompasses a description of the target group and the different roles and responsibilities of the participants e.g. the role of the manager, the work environment representative and the employees. There is also a thorough description of the activities within the intervention and instructions to guide the participants through the process. 3.2 The organisation and political framework of the Prevention Packages The PPs are designed and developed by researchers from the National Research Centre for the Working Environment (NRCWE) in collaboration with the Danish Working Environment Authority. The social partners from unions and employers associations and the PF are additional contributors to the development of the PPs. There are several political demands in the concept. First, the PPs should focus on essential work environment problems with a special focus on small workplaces. The aim of the PPs is to reduce musculoskeletal disorders, improving the psychosocial work environment and promoting health in high-risk sectors and each PP should exceed the realm of the law. Second, the PPs should be relevant in terms of low costs, because there is an aspiration to reach as many workplaces as possible. The PPs should consist of effective solutions that can function within the specific sector, and are realistic and easy to implement for small workplaces with a minimum of external support, and that will be anchored after completion. Third, the PPs should be adjusted to the target group and the specific sector e.g. the presentation of the interventions should be in accordance with the language and culture of the sector, the problems and solutions should be relevant to the target group. WEA has planned a separate inspection of the same sectors that are offered PPs. The purpose of this separate inspection is to ensure a broad dissemination of information and knowledge about the offer of PPs. 3.3 Evaluation of the Prevention Packages The PP will be evaluated by NRCWE with the aim of documenting how the implementation of the PPs proceeds, and whether the PPs are implemented as expected (NFA 2010). Another aim of the evaluation is to document how the PPs are received by the workplaces, and how the context impact the implementation. Finally, the evaluation intends to test the effect of the PPs. The evaluation is focused on collecting information about the workplaces and the process of implementing the PPs. The data is therefore collected before, during and after the implementation, and the evaluation combines different data sources. The evaluation model consists of a quantitative part and a qualitative part. The quantitative part encompasses questionnaires at baseline and follow-up to all the participants of the PPs. The managers additionally have to fill out another questionnaire about the general circumstances at the workplace and the implementation of PPs. The qualitative part encompasses observations, interviews with single informants as well as focus group discussions at selected workplaces. 4. Discussion The initiative of the PPs is political where the aim is to reach a target group subjected to increased risk of physical and mental wear and tear. The challenge is how to target these groups, and whether the participants are motivated and qualified to implement the PP. The political aim is that the PPs should be implemented with a minimum of external support. On one hand this could result in a better chance for the workplaces to get committed to the project and it could possibly lead to a continuation of the behavior changes and increased awareness of work environment after completion of the PP. On the other hand it puts up requirements for the workplaces capacity and ability to implement the PPs on their own. Research suggests that small workplaces cannot be expected to have much 285

282 motivation to engage in issues such as the work environment due to the perception that this is not relevant to their core business (Legg et al. 2010). It is therefore interesting whether and to what extend the financial support to implement the PPs will be an incentive for the small workplaces to engage in issues related to the work environment. The inspection of the sectors offered PPs may also have an impact on the motivation and engagement in the implementation of the PPs. It will be interesting to explore whether and to what extend this will influence the process. All the PPs should be evidence-based - meaning transforming collected information about the relevant work environment factors and tested methods and solutions in the sector into an intervention. The political rationale is that by focusing on evidence-based research it is expected that the method should work. Whether this expectation can be fulfilled depends on many factors. The implementation of the PPs relies on whether the methods and result from research can be adapted into this specific context of small Danish workplaces as well as the actual workplace s interpretation of the PP. Each workplace is different and interprets the PPs in different ways. This requires the PPs to be realistic and flexible in order to ensure that most workplaces can implement them. Due to the differences in implementation, the evaluation of the PPs needs to be based on a flexible evaluation model. It is suggested that an evaluation of interventions targeted small workplaces (like the PPs) should take different aspects into account (Hasle & Limborg 2006;Legg, Olsen, Lamm, Laird, Harris, & Hasle 2010). One aspect is how the small workplaces can be reached, and another is whether the intervention could work within the actual workplace. In relation hereto, it is important to understand the mechanisms that influence whether any intervention will work, and to understand the context that can either impede or promote the adoption, success and effect of the intervention. The contextual factors are often unpredictable, causing the interventions to be complicated and complex. The evaluation of interventions like the PPs therefore has to cover not only whether the PPs has worked or not, but how it was implemented, for whom it worked and at which type of workplace. The aim of the evaluation is to identify the important mechanisms when implementing interventions such as PPs within small workplaces. 5. References Axelsson, C. 2002, Formalisering som hinder & möjlighet i småföretag. En studie av arbetsmiljöarbete ur ett lärandeperspektiv., Forskning Ja, Institutionen för Arbetsvetenskap. Avdelningen för Industriell Produktionsmiljö. Luleå Tekniska Universitet. BM. Lov om Forebyggelsesfonden. Beskæftigelsesministeriet (The Danish Ministry of Employment) Ref Type: Electronic Citation BM. Aftale om Forebyggelsesfonden. Beskæftigelsesministeriet (The Danish Ministry of Employment) Ref Type: Electronic Citation BM. Aftale om at forny Forebyggelsesfonden. Beskæftigelsesministeriet (The Danish Ministry of Employment) Ref Type: Electronic Citation Champoux, D. & Brun, J. 2003, "Occupational health and safety management in small size enterprises: an overview of the situation and avenues for intervention and research", Safety Science, vol. 41, no. 4, pp

283 Cooke, P. & Wills, D. 1999, "Small firms, social capital and the enhancement of business performance through innovation programmes", Small Business Economics, vol. 13, pp Davis, A. E., Renzulli, L. A., & Aldrich, H. E. 2006, "Mixing or matching? The influence of voluntary associations on the occupational diversity and density of small business owners networks", Work and Occupations, vol. 33, no. 1, pp Didrichsen, F. 2011, "Ulighed i Sundhed," in Medicinsk Sociologi - Sociale faktorers betydning for befolkningens helbred, R. Lund, U. Christensen, & L. Iversen, eds., pp Eakin, J. 1992, "Leaving it up to the workers: Sociological perspective on the management of health and safety in small workplaces", International Journal of Health Services, vol. 22, no. 4, pp Forebyggelsesfonden. Forebyggelsespakker. Forebyggelsesfonden Ref Type: Electronic Citation Hasle, P., Kines, P., & Andersen, L. P. 2009, "Small enterprise owners' accident causation attribution and prevention", Safety Science, vol. 47, no. 1, pp Hasle, P. & Limborg, H. J. 2006, "A review of the literature on preventive occupational health and safety activities in small enterprises", Industrial health, vol. 44, no. 1, pp Hasle, P., Limborg, H. J., Ledskov, A., & Nalholm, E. 2004, Arbejdsmiljøarbejdet i mindre og mellemstore virksomheder - en litteraturanalyse, Institut for Produktion og Ledelse, DTU, Lyngby. Hoque, K. & Bacon, N. 2006, "The antecedents of training activity in British small and mediumsized enterprises", Work, Employment and Society, vol. 20, no. 3, pp Ito, A., Sakai, K., & Kogi, K. 2006, "Development of interactive workplace improvement programs in collaboration with trade associations of small-scale industries", Industrial health, vol. 44, no. 1, pp Legg, S., Olsen, K., Lamm, F., Laird, I., Harris, A.-L., & Hasle, P. 2010, "Understanding the programme theories underlying national strategies to improve the working environment in small businesses", Policy and Practice in Health and Safety, vol. 8, no. 2, pp MacEachen, E., Kosny, A., Scott-Dixon, K., Facey, M., Chambers, L., Breslin, C., Kyle, N., Irvin, E., Mahood, Q.,, & The Small Business Systematic Review Team 2010, "Workplace Health Understandings and Processes in Small Businesses: A Systematic Review of the Qualitative Literature", Journal of Occupational Rehabilitation. NFA. Evaluering i forbindelse med udvikling af Forebyggelsespakker. Det Nationale Forskningscenter for Arbejdsmiljø (The Danish Research Institute for the Workning Environment) Ref Type: Unpublished Work Rasmussen, C. N., Kvorning, L. K. V., & Hasle, P. "Elabotion of The Prevention Packages: a predefined concept to prevent fhysical and mental wear and tear within the "Construction industry" and the "Home care and residental care sector"", in NES

284 Vickers, I., James, P., Smallbone, D., & Baldock, R. 2005, "Understanding small firm responses to regulation: the case of workplace health and safety", Policy Studies, vol. 26, no. 2, pp Walters, D. 2006, "The efficacy of strategies for chemical risk management in small enterprises in Europe: evidence for success?", Policy and Practice in Health and Safety, vol. 4, no. 1, pp

285 TOWARDS SUISTAINABLE WORK: HOW LEADERSHIP AND GENERAL LIFE SATISFACTION AFFECTS ON EMPLOYEES OCCUPATIONAL WELL-BEING? Liisa Mäkelä, Riitta Viitala and Sari Hölsö University of Vaasa, Department of Management, P.O.Box 700, VAASA, Finland. The purpose of this paper is to study how coaching leadership, leader-member exchange relationships, life satisfaction and occupational well-being are related to each other. The quantitative data (N 114) was collected by questionnaires from employees of four business units in a logistics company. Using regression analysis, our results show that coaching leadership and LMX relationships are statistically significantly related to job satisfaction and job strain. Moreover, general life satisfaction explains statistically significantly job satisfaction. Using cluster analysis we identified four groups representing different kind of working life experiences. The groups were named: we can do this, slaving away, nine to fivers and the happy-go-luckies. The sub-unit and the length of the LMX relationship were related to the composition of the group. Keywords: Job Well-Being, Coaching leadership, Leader-Member Exchange relationship, General Life Satisfaction 1. Introduction Occupational well-being refers to an employee s ability to manage his / her daily workload. Factors like the physical, mental and social condition of the employee, as well as the working environment and work community all relate to this ability (The Ministry of Social Affairs and Health in Finland, 2005:17). Job wellbeing is regularly studied through concepts such as commitment, job satisfaction and work-life balance (Baptiste, 2008). Job satisfaction, a very important element of job well-being, can be defined as a person s satisfaction or dissatisfaction with their job and with other factors related to the job (e.g. wages, colleagues) (Danna and Griffin, 1999; Ghazzawi, 2008). The negative side of job well-being can be studied through considering workload or job strain, focusing on the extent to which individuals perceive their workloads as onerous. In this study, job well-being is studied through job satisfaction and job strain. One of the most important antecedents related to job well-being is the way in which people in organizations are managed (e.g. Moyle, 1998; Gardner and O Driscoll, 2007). The key person in the leadership process is the employee s immediate supervisor, as they have the ability to, for instance, increase job satisfaction through supervisory support and also to create stress by unfavourable leadership behaviour (Kuoppala et.al, 2008). Leadership can be seen as a process occurring between supervisor and the subordinates. Leader-Member Exchange theory (LMX) (see Graen and Uhl-Bien, 1995) focuses on leadership from this perspective. Each supervisor-subordinate dyad is unique and the quality of the dyad varies from low to high. Earlier studies have shown that the quality of LMX relationship is related to job satisfaction; higher LMX quality relates to higher job satisfaction (Erdogan and Enders, 2007). A leadership style which empowers employees to exceed prior levels of performance has recently often defined as coaching (Evered and Selman, 1989). The idea of coaching is to ensure employee s job satisfaction, learning and good performance simultaneously. Therefore, both of these perspectives on leadership; coaching leadership and LMX relationships are taken into account in this paper. 289

286 Occupational well-being is not only the consequence of organizational aspects. Also non-work elements, e.g. work-family conflicts, are found to be important (refs). However, there is a dearth of empirical studies taking account both leadership and general life satisfaction perspectives and therefore general life satisfaction is studied in this paper together with coaching leadership and LMX relationships. The aim of this paper is to study empirically how coaching leadership, leader-member exchange relationships, general life satisfaction and job well-being relate to each other. Next, the theoretical basis of this study is presented, followed by the description of the study methodology and the results of the study. At last we present some conclusions. 2. Occupational well-being, general life satisfaction and leadership Recent decades have seen the general discussion of well-being in general, and at workplaces in particular, increase dramatically. In daily speech well-being is usually meant to be a comprehensive sense of a good feeling about life as a whole or good physical health. Researchers have previously been interested in elements of well-being and how it is experienced and the antecedents and consequences of well-being (Danna and Griffin, 1999). One of the most researched themes in organizations is job satisfaction (Ghazzawi, 2008). Although many researchers have used job satisfaction as a measure of affective well-being and especially in measuring happiness, some of their colleagues have criticized the approach for ignoring the employee s life outside work (Schultz, 2008; Wright and Cropanzano, 2000). Judge and Locke (1993) consider that the relationship between well-being and job satisfaction is related to how important work is in the employee s life as a whole. Workload, or strain, can be physical or mental. The mental workload can be experienced when an employee feels that the demands of work are relatively higher than the employee s locus of control (i.e. the degree to which the employee has the required skills and knowledge to manage their work and the opportunity to control their work) (Karasek, 1979). Number of studies have found out, that the three most common factors involved in job dissatisfaction are work demands, lack of support and lack of opportunity to control the work (Way and MacNeil, 2006). When work is mentally demanding over an extended period and the demands are strong enough, the employee is likely to experience stress which may bring broader problems like burnout (Maslach and Jackson, 1981). The way that employees are managed is related to job well-being (e.g. Baptiste, 2008). Nevertheless, prior research about the relationship between leadership and job well-being has viewed this dimension quite superficially and therefore we shortly discuss on coaching leadership and LMX-research more thoroughly. 3. Coaching leadership and LMX relationships Coaching leadership style has been said to be effective in rapidly changing work environments. Among others, better motivation, lower staff absence and improved employee retention have been claimed to be the benefits of developing coaching leadership in a company (Pollit 2009). Essential features in relationship between a coaching leader and a follower are open communication (Ellinger et.al. 1999), constructive feedback, which generates a feeling that people are respected and valued, and mutual trust. Important characteristics connected to coaching leaders are empathy, honesty and neutrality, motivation to act with coaching methods, the belief that each employee has the potential to learn and develop (Whitmore, 2007:16), and the ability to recognize the needs of employees and adopt a proper coach role whenever it is needed (Viitala, 2007). In general, literature on coaching leadership focuses on a leader and it is generally assumed that coaching leadership is a single entity that can be experienced collectively in the same way. However, it has been discovered, that employees assessments of coaching diverge even when they assess the same leader (Viitala, 2004) 290

287 LMX is based on the argument that leaders and their followers create dyadic working relationships which differ from each other in quality. Leader-follower relationships are mutually constituted and co-produced (Collinson, 2005; Mäkelä, 2009) and fundamentally reciprocal. The status of these relationships is seen as a continuum with high quality relationships at one end and low quality leader-follower dyads at the other (Liden and Maslyn, 1998). Relationships between leaders and their followers are supposed to develop rather quickly and then remain stable. 4. Method The original sample (N 114) included employees from four business units of one large organization in the logistics-sector. The subunits structure and situational factors differed from each other. There were three relevant differences between the units: 1) in one of them the supervisor was new and had worked with the subordinates for only two weeks at the time this data collected, 2) one of these subunits is located in four separate locations and the supervisor visited each place at least once a week, and 3) one unit is considerable bigger than others, even though the number of respondents was about the same than from other units. The data collection was performed in autumn 2009, using a questionnaire distributed and collected by a researcher to each employee at a workplace meeting. The questionnaire included scales for measuring Leader-Member Exchange, Coaching Leadership, General Life Satisfaction and Occupational Well-being through job satisfaction and job strain. The items were rated on a 5-point scale ranging from 1 (totally agree) to 5 (totally disagree) and a high score on each scale indicated a high level of the particular experience. Cronbach s alphas for each scale were Leader-Member Exchange.96; coaching leadership. 0.94; General Life Satisfaction 0.61; Occupational Well-being, job satisfaction 0.89 and job strain Due to limited length of the paper, more precise information on our data and measurement scales is available from authors. 5. Results Linear regression analysis were used for analyzing whether coaching leadership, LMX relationships and general life satisfaction predict job satisfaction and job strain. Due to correlation between LMX and Coaching leadership, separate linear regression analysis were used to analyze how these leadership aspects predicted job well-being. All analyses were adjusted for the effect of age, gender, family/ marital status, supervisor, type of the employment contract (permanent/ fixed-term), length of the employment contract to employer and length of the LMX relationship. Initial analysis revealed no significant interactions between these background variables and job satisfaction and job strain. Therefore, all results presented in this paper are based only on main effects models. Table 3 presents the associations between coaching leadership, LMX, general life satisfaction and job satisfaction and job strain. After adjustment the background variables, coaching leadership, LMX and general life satisfaction predicted higher job satisfaction and lower job strain. General life satisfaction and Leadership (LMX and Coaching leadership) predicted job well-being almost in similar extent. Table 3. Coaching Leadership, LMX relationships and General Life Satisfaction predicting Job satisfaction and Job Strain. beta t p-value r^2 chance Job satisfaction 0,203 Coaching Leadership 0,366 4,246 0,000 General Life Satisfaction 0,288 3,657 0,000 0,183 Leader-Member Exchange 0,317 3,632 0,

288 General Life Satisfaction 0,337 4,298 0,000 Job strain 0,202 Coaching Leadership 0,408 4,383 0,000 General Life Satisfaction 0,258 3,045 0,003 0,143 Leader-Member Exchange 0,281 2,836 0,006 General Life Satisfaction 0,297 3,339 0,001 To gain more a holistic view of individuals experiences of their working lives, we used cluster analysis, including of both leadership and well-being. Using a K-Means Cluster Analysis, revealed four groups (sig.=,000) within our data. Each group was large enough for statistical analysis, and we also named the groups in order to highlight their typical features. Table 5 presents the means for each group of phenomena in this study. Group one was named we can do this (N=23) and typically this group perceived leadership (LMX and coaching leadership) as excellent and job satisfaction as acceptable. Job strain did emerge to a certain degree within this group of people. Group two was named slaving away (N=18) and featured respondents with very low levels of job satisfaction and high levels of job strain. Their relationship with their leaders was neutral and the leaders were not perceived as coaches. The existence of this group of employees is of course alarming and the organization needs to act upon it. The third group named nine to fivers (N=32), reported their experience of each phenomena in the study, that is both leadership and well-being as adequate. The fourth group (N=31), the happy-go-luckies comprised those whose perceptions of coaching leadership, LMX relationships, job satisfaction and manageability of job strain were highest. The quality of LMX relationships was very high and the cluster mean was 4,71. Supervisors were also perceived very much to be coaching (mean 4,42) by this group. Job satisfaction was also very good (mean 4,359 and manageability of job strain was good (mean 4,27). When we focused attention on respondents from a certain group, we did not find that gender, age, family situation, type of employment contract (fixed term/ permanent), length of employment with present employer were statistically significant to that relationship. Two variables were found which explained the group composition to some extent. The first and stronger relationship was between group composition and the unit where participants worked. The other relationship was between the group and the length of the LMX relationship. In the last section of this paper, we discuss the findings of this study and draw its conclusions. 6. Conclusions and discussion The contribution of this study is that it looks at the relations between four factors parallelly: the superior s coaching behaviour, the leader-member relationship, general life satisfaction and the job well-being experienced. This study found that 1) good leadership is significantly related to employees experiences of job-related well-being, 2) good relationships between superiors and employees are statistically related to the employees experience of a strong sense of job well-being, 3) coaching leadership is related to good relationships between superiors and employees, and 4) general life satisfaction has a crucial role in job wellbeing. Even though organizational circumstances, such as leadership, psychosocial work environment etc. are important, these are not the only dimensions affecting individuals experience of job well-being. Four groups stood out and were given names we can do this, slaving away, nine to fivers and the happy-go-luckies. Each of the four types could be found in each of the business units, and led by the same 292

289 leader. This confirms that both leadership and personal job well-being are experienced individually. The relationships with the same leader vary in a group of subordinates and their connection to the experience of the person s job well-being seems more complicated than the merely linear. This merits further investigation with a larger dataset. To sum up, our research has several practical implications for business: first, developing leadership of supervisors should be important points of reference, even when the aim is to further job well-being. Second, when developing leadership, attention should be paid to superior-employee relationships and not just the superiors work, as traditional leadership training usually does. Third, when job well-being is on focus in work places the general life situation of employees should be added to discussion as well as to measurement scales. Our research also has certain limitations. The material in this study is relatively narrow and has a skewed distribution. The results are, however, clear and sufficiently guiding to say that the research should be continued with a larger dataset and different research methods. From the perspective of employees wellbeing, future research also should take into account individual features. Additionally leaders own job wellbeing merits further research, because their work has become more challenging with societal development and organizational changes. References Baptiste, N., 2008, Tightening the link between employee wellbeing at work and performance. A new dimension for HRM. Management Decision, 46: Collinson, D., 2005, Dialectics of leadership, Human Relations, 58: Danna, K. and R.W. Griffin, 1999, Health and well-being in the workplace: a review and synthesis of the literature. Journal of Management, 25: Ellinger, A. D. and R. P. Bostrom, 1999, Managerial coaching behaviors in learning organizations. Journal of Management Development, 18: Erdogan B. and J. Enders, 2007, Support from the top: supervisors' perceived organizational support as a moderator of leader-member exchange to satisfaction and performance relationships. Journal of Applied Psychology, 92: Evered, R. D. and J. C. Selman, 1989, Coaching and the art of management. Organizational Dynamics, 18: Gardner, D. and M. O Driscoll, 2007, Professional wellbeing. In I. M. Evans, J. J. Rucklidge and M. O Driscoll (Eds). Professional practice of psychology in Aotearoa New Zealand. Wellington: The New Zealand Psychology Society Inc.; pp Ghazzawi, I., 2008, Job satisfaction antecedents and consequences: A new conceptual framework and research agenda. The Business Review. Cambridge 11(2): Graen, G. B. and M. Uhl-Bien, 1995, Relationship-based approach to leadership: Development of leadermember exchange (LMX) theory of leadership over 25 years: Applying a multi-level multi-domain perspective. Leadership Quarterly, 6: Judge, T. A. and R. J. Locke, 1993, Effect of dysfunctional thought processes on subjective well-being and job satisfaction. Journal of Applied Psychology, 78: Karasek, R. A., 1979, Job demands, job decision latitude and mental strain: Implications for job redesign. Administration Science Quarterly, 24: Kuoppala, J., A. Lamminpää, J. Liira and H. Vainio, 2008, Leadership, job well-being, and health effects a systematic review and meta-analysis. Journal of Occupational and Environmental Medicine, 50: Liden, R. and J. Maslyn, 1998, Multidimensionality of leader-member exchange: An empirical assessment through scale development. Journal of Management, 24: Maslach, C. and S. Jackson, 1981, The measurement of experienced burnout. Journal of Occupational Behavior, 2: Moyle, P., 1998, Longitudinal influences of managerial support on employee well-being. Work & Stress, 12(1):

290 Mäkelä, L., 2009, Women s leader-member relationships during pregnancy and the return to work. Acta Wasaensia. No Vaasa: University of Vaasa. Pollitt, D., 2009, Leadership training gets medical company fit for the future.training & Management Development Methods, 23(4): Schultz, M. L., 2008, Occupational well-being: the development of a theory and a measure. Kansas State University. Dissertation. Schyns, B. and H.-J. Wolfram, 2008, The relationship between leader-member exchange and outcomes as rated by leaders and followers. Leadership & Organization Development Journal, 29: Sosiaali- ja terveysministeriö, 2005, Työhyvinvointitutkimus Suomessa ja sen painoalueet terveyden ja turvallisuuden näkökulmasta. Sosiaali- ja terveysministeriön selvityksiä 25. Helsinki. Viitala, R., 2004, Towards a Theory of Knowledge Leadership. The Leadership & Organization Development Journal, 25: Viitala, R., 2007, Esimiehestä coach. In M. Räsänen (Ed.). Coaching ja johtajuus. Valmentava ote esimiestyössä. Edita. Way, M. and M. MacNeil, 2006, Organizational characteristics and their effect on health. Nursing Economics, 24(2): Whitmore, J., 2007, Coaching for performance. London: Nicholas Brealey Publishing. Wright, T. A. and R. Cropanzano, 2000, Psychological well-being and job satisfaction as predictors of job performance. Journal of Occupational Health Psychology, 5:

291 PROMOTING OCCUPATIONAL HEALTH, SAFETY AND WELL-BEING BY TRAINING LINE MANAGERS Tappura, S. 1, Hämäläinen, P. 2 1 Center for Safety Management and Engineering, Industrial Management, Tampere University of Technology, Finland 2 VTT Technical Research Centre of Finland This paper presents an outline of the management safety training, and experiences from a training programme carried out in a large Finnish manufacturing company. The training was designed to develop the safety competence of the line managers and improve their commitment to the revised safety policy of the company. The training helped the managers to better outline their duties, to commit themselves to the unified safety procedures of the company and to promote these procedures throughout the organisation. The training feedback helped the top management in future development and training. Keywords: management safety training, management safety competence, safety procedures 1 Introduction 1.1 Theoretical framework Safety research and literature generally addresses managers roles in promoting occupational safety. Managers are commonly considered to be key factors in implementing safety improvements and raising safety issues since they have the capacity and power to make decisions about safety investments and can influence a workplace s safety culture (e.g. Dedobbeleer & Béland 1998; DeJoy et al. 2004; Fernández-Muñiz et al. 2009; Flin et al. 2000; Flin 2003; Hofmann & Stetzer 1996; Maurino et al. 1995; Rundmo 1996; Rundmo & Hale 2003; Zohar 1980). The safety competence of managers is thus essential. According to Simola (2005), the safety awareness, competence and commitment of supervisors and managers are important factors for achieving positive results. Zohar (2002) found in his study that training supervisors to increase their monitoring behaviours and rewarding workers safety behaviours positively affected injury rates and safety climate scores. Line managers are responsible for implementing the safety policy and procedures in an organisation. However, in many cases, the safety competence of line managers is insufficient given that they may be missing out on safety training (Kletz 1991; Palukka & Salminen 2003; Simola 2005). Therefore the managers may not be aware of their responsibilities or the company safety policy; also, safety procedures may not be known and implemented properly, or they may vary among departments inside the company (Carder & Ragan 2005). To establish a unified and strong safety culture in an organisation, designing and implementing training and education programmes for line managers is crucial. Training provides managers with competence and tools for safety management. Safety training provides managers with knowledge of their responsibilities and of company-wide safety policies and procedures. Furthermore, it influences their perceptions and attitudes toward safety. (Carder & Ragan 2005) 295

292 Information on good practices and on the effectiveness of safety training is needed in order to develop safety-training programmes for managers. A general outline of the safety-training programme is needed in order to develop company-specific training programmes in different kind of organisations. 1.2 Background of the case company This paper is based on experiences from a safety-training programme held in a large Finnish manufacturing company approximately 600 employees in autumn of The reason for the training was that the occupational-accident rate was high compared to rates of other companies in the same business sector; as well, a number of incidents had recently occurred. In addition, it was found that the company had several different safety standards and cultures depending on each department. Also, safety methods and rules partly overlapped and were too complex to follow. The top management of the company had recognised these safety problems and wanted to change the situation. Committed to working on safety, they reorganised the safety organisation of the company and launched a safety programme to improve the safety level. Safety training for all personnel was planned, but the training of the pilot group of the line managers was seen as the most important for initiating the change. 2 Objectives The objective of this study was to design an outline of the content of management safety-training programmes in order to raise both the overall safety awareness and competence of the managers and their commitment to safety. The training programme was developed and tested in a large Finnish manufacturing company. In the case company, the objective of the training was also to improve the managers commitment to renewed safety policy and safety procedures developed for the company. This paper presents the contents and common experiences of the training programme that was conducted in the company. 3 Methods Based on the needs of the company, a safety-training programme for the line managers was planned out in close collaboration with the safety management of the company and two safety specialists (the authors). The preliminary programme was designed by the safety specialists and was based on the managers safety responsibilities according to the Finnish Occupational Safety and Health Act (Työturvallisuuslaki 738/2002). The programme was accepted and committed to by the top management. The training was based on joint participation by the attendees and on company-specific case and procedures. The theoretical background and examples of safety procedures and methods (e.g. accident investigation, risk assessment and accident cost calculation) were presented by the trainers and were then practiced, discussed and developed by the attendees. During the training, feedback about the company safety procedures and policy was collected and sent to the top management. Instantly after training, the participants were asked for feedback about the training. After one year, the participants were sent a subsequent inquiry by asking whether they had changed their safety behaviour and procedures due to the training. The feedback was reported to the safety manager. The safety manager was also interviewed regarding his assessment of the changes made due to the training. 4 Results The safety training for the line managers was arranged in November There were nineteen participants (including the safety manager) representing different departments of the company, such 296

293 as production, maintenance and quality control. The training lasted two days. The jointly developed safety-training outline consisted of the following main subjects: motivation and justification for safety an overview of Finnish safety regulations managers safety responsibilities information about occupational injuries and sickness absences in Finland economic aspects of safety how to following safety procedures in the company - occupational injuries reporting and investigating - risk assessing and anticipating - safety suggestions and dangerous-situation reporting - safety-performance measuring and reporting - corrective-actions control During the training, the matters that hinder promoting safety in the company were discussed. According to the participants, the most important things to pay attention to promote safety were the following: top management s commitment to safety and their demonstration of it unified and simple safety-management system and procedures defined and clear safety-goals good safety competence and motivation effective interaction between departments and business units workable induction training, for managers and officers as well personal protective equipment use and control cleanliness and orderliness effective safety-performance measurement and control integrity and open communication concerning safety issues. These are steps that managers themselves should take into consideration during everyday operation, and they should motivate employees to work towards them. The managers tools for safety management were also discussed. According to the participants, managers need competence and unified procedures, especially for: communication (safety meetings and discussions) accident investigation (an investigation model and information sharing between departments) risk assessment (information sharing between departments and corrective-actions control). The feedback from the training programme was collected at the end of the training. The feedback from the training was positive. The participants received important information regarding their legal requirements and the economic aspects of safety. The training helped the managers to better outline their duties and to commit themselves to the coherent/unified safety practices of the company. They liked the way the training was arranged, including the discussions, group works, interactive lectures and company-specific cases. However, they felt they needed even more information about legal aspects and a more practical approach to the safety issues. The feedback concerning safety issues and safety practices that had been developed was collected during the training and reported to the top management by the trainers (the authors). It helped the 297

294 company s top management develop adequate safety practices and promote their adoption and introduction into the whole organisation. The feedback also helped improved future managementtraining programmes. One year after the training programme, the participants and the safety manager were asked about their practical experience regarding the training and whether they had changed their safety behaviour and procedures due to the training. Six participants answered the inquiry, and the safety manager was interviewed. According to the respondents and the safety manager, the main benefits of and knowledge gained from the training were the increased awareness of the safety procedures and of the manager s role and responsibilities concerning occupational safety. Some of the respondents had changed their behaviour due, at least partly, to the training. They now more strongly emphasised safety issues when developing new operations and in daily routines, and they found cleanliness and orderliness to be important for developing safety. They also encouraged safety observation, near-miss reporting and personal protective equipment use in their areas of responsibility. After the training, they had further developed the safety procedures in the company. For example, they had started company-wide meetings to review actual accidents and near misses in order to learn from them. 5 Discussion There were some safety problems that required that the case company take action, obtain better safety competence and unify safety procedures throughout the company. The training programme was designed to raise the safety awareness and competence of the managers and their commitment to safety. The training for the line managers contributed to the company-wide safety-development programme, and the company-specific safety problems were discussed during the training. The training gave managers an overview of their responsibilities and useful safety procedures. During the training, the managers had time and possibility for thinking about their reactions in challenging situations. Examples of such situations and actions were discussed. Peer communication between the managers was seen as very important and as necessary to continue after the training as well. The experiences and feedback from the safety training were positive. The top management in the company utilised the feedback to develop both a company-wide safety programme as well as safety procedures. Based on the feedback, they decided which practices would be implemented across the whole organisation. And the training itself was an important part of the implementation because the participants were mostly line managers from different departments. However, the other managers and supervisors as well as employees should also be trained in order that they may be motivated and inspired to change their safety behaviour. Otherwise the effects of the line managers training might become ineffective. Training is effective when it causes changes in job performance (Clegg 1987). Since the training, the participants have perceived improvements in the safety climate and culture due to actions carried out according to the company safety programme. For example, near-miss reporting activity has grown, and the daily emphasis on safety issues has increased. However, the participants do not see a direct relation between training and safety-culture development. It is difficult to say which improvements are due to training and which are due to the company-wide safety programme. In future, managers still need training and guidance regarding safety issues. In fact, safety issues shall be highlighted at all times. The developed training programme can be used as a preliminary outline for future safety-training programmes in different kinds of organisations. The main conclusion is that there are certain safety issues that should be included in a management safety training, such as management 298

295 responsibilities, continual improvement, communication, control and measurement. However, emphasis on these issues depends strongly on the current competence of the managers and the organisation s level of safety. The lower the safety level, the greater the number of fundamental issues that needs to be included in training. The experiences of this training programme shall be taken into account when designing new programmes. However, every safety-training programme should be designed in close co-operation with the respective organisation based on its needs and objectives and should be evaluated against these objectives (Harvey et al. 2001). Based on the experiences of this safety-training programme, some suggestion for effective training programmes for the managers is presented. Joint discussions, even debating, can construct a shared understanding of safety issues and promote commitment to safety procedures. During the training, it is important to use company-specific cases and procedures to link theory and practice. According to Weidner et al. (1998), safety training should include demonstrations and hands-on techniques. The trainers should only present examples and preliminary models of safety procedures, which the participants can then practice, develop and implement by themselves to strengthen their commitment to these procedures. Furthermore, the legal responsibilities of the managers should be emphasised, and interference with regards to misconduct should be discussed. Understanding the economic aspects of safety would help prioritise competing goals and motivating all employees to invest in a safe work environment. 6 References Carder, B. & Ragan, P Measurement matters. How effective assessment drives business and safety performance. ASQ Quality Press, Milwaukee, Wisconsin. Dedobbeleer, N. & Béland, F Is risk perception one of the dimensions of safety climate? In: Feyer, A., Williamson, A. (Eds.), Occupational Injury: Risk, Prevention and Intervention. Taylor and Francis, London. DeJoy, D.M., Schaffer, B.S., Wilson, M.G., Vandenberg, R.J. & Butts, M.M Creating safer workplaces: assessing the determinants and role of safety climate. Journal of Safety Research 35, Fernández-Muñiz, B., Montes-Peón, J. M. & Vázques-Ordás, C. J Relation between occupational safety management and firm performance. Safety Science 47, Flin, R Danger - men at work : Management influence on safety. Human Factors and Ergonomics in Manufacturing, 13, Flin, R., Mearns, K., O'Connor, P. & Bryden, R Measuring safety climate: identifying the common features. Safety Science 34, Harvey, J., Bolam, H. Gregory, D. & Erdos, G The effectiveness of training to change safety culture and attitudes within a highly regulated environment. Personnel Review, Vol. 30 No. 6, Hofmann, D.A. & Stetzer, A A cross-level investigation of factors influencing unsafe behaviours and accidents Personnel. Psychology 49, Kletz, T Process safety an engineering achievement.. Proceedings of the Institution of Mechanical Engineers, Part E: Journal of Process Mechanical Engineering, v 205, n E1, p Maurino, D., Reason, J., Johnson, N. & Lee, R Beyond aviation human factors. Aldershot: Ashgate Palukka, P. & Salminen, S Työturvallisuuskoulutuksen valtakunnallinen selvitys (The national study of safety training). (In Finnish) Rundmo, T Associations between risk perception and safety. Safety Science 24, Rundmo, T. & Hale, A Managers attitudes towards safety and accident prevention. Safety Science 41,

296 Simola, A Turvallisuuden johtaminen esimiestyönä. Tapaustutkimus pitkäkestoisen kehittämishankkeen läpiviennistä teräksen jatkojalostustehtaassa (Safety leadership as a line supervisor's task. A case study of the implementation of a long-term development project at a steel works). Doctoral dissertation, University of Oulu, Department of Industrial Engineering and Management, Work Science, Finland (In Finnish). Weidner, B. L., Gotsch, A. R., Delnevo, C. D., Newman, J. B. & McDonald, B Worker health and safety training: Assessing impact among responders. American Journal of Industrial Medicine, 33: Zohar, D Safety climate in industrial organizations: theoretical and applied implications. Journal of Applied Psychology 65, Zohar, D Modifying supervisory practices to improve sub-unit safety. A leadership-based intervention model. Journal of Applied Psychology, 87,

297 ESSENCE OF WELL-BEING AT WORK: ANALYSIS OF INTERVIEWS Jounila, H 1 ; Autio, T 1 ; Paananen, H 1 and Reiman, A 2 1. Department of Industrial Engineering and Management, University of Oulu, P.O.Box 4610, FI University of Oulu, Finland 2. City of Oulu, Oulu, Finland The aim of this study was to define what kinds of factors social and health care sector personnel include in the term well-being at work, and which of these are most important to them. In the previous phase of the project the concept of well-being at work was formulated through expert interviews and the results were integrated into a work system framework. The results of that expert study were utilised in the interviews and a paired comparison form. Keywords: well-being at work, work system model, social and health care sector 1. Introduction Well-being at work has been defined, for example, by the Finnish Institute of Occupational Health, as safe, healthy, and productive work in a well-led organization by competent workers and work communities who see their job as meaningful and rewarding, and see work as a factor that supports their life management (Anttonen and Räsänen 2008). In addition, numerous other definitions, also briefly presented ones, are available, such as well-being at work means employees capacity to manage and cope their work tasks (Research on Well-Being at Work in Finland Focusing on Occupational Health and Safety 2005). Besides Finnish institutional-level definitions, also several individual researchers have debated about the concept of well-being at work in Finland (e.g. Hakanen 2002; Marjala 2009). In an earlier study by our research group, the concept of well-being at work was formulated through expert interviews and integrated into a work system framework (Autio et al. 2011). The work system model is a systematic way to describe all the dimensions of work that affect a worker and outcomes. The model includes five elements that interact with each other. These elements are a person who performs his/her tasks using tools (technology) needed in his/her working environment and work organisation. If a change occurs in some element of the work system, it may cause many changes in other work system elements (Carayon 2009). The goal is to balance the elements in a way that satisfies the employee and enhances the quality and effectiveness of work (Carayon and Smith 2000; Smith and Sainfort 1989; Väyrynen, 2010). 2. Objectives Definitions often aim to tell the crux of the matter in a relatively short form. In such cases many important things must be eliminated. There were many factors of well-being at work in the work system model resulting from the expert interviews (see Fig. 1). The main objective of this study was to find the most important elements and factors of well-being at work in the social and health care sector, and in particular to answer the question of what is the essence of well-being at work in this field. 301

298 INPUT Technology and Tools Machine safety Product safety Person Physical and mental health Motivation Competence Self-actualisation Individual values Commitment to work Commitment to values and rules Personal goals Understanding basic tasks and one s own position Communication skills Ability to deal with emotions Balance between work and private life Attitude towards changes Ability to deal with feedback Organisation Management skills and processes Human relations at work Organisational values and rules Change management Supporting individuals through changes Inspiring community Safety culture Transparency in communication processes Feedback procedures Conflict procedures Solidarity, togetherness and commitment Trust and confidentiality Cooperation includes all (Preventive) Occupational health care HR processes Flexibility Solution-focused Acceptance of diversity Workplace skills Tasks Possibility to work safely Work load Versatility Sensibility Success in work Possibility to affect work Possibility to participate in development Environment (work) Safe environment Distruption-free OUTCOMES Wanted Unwanted Figure 1. Factors of well-being at work according to the expert interviews in the work system model (Autio et al. 2011; Sinisammal and Kiviniemi 2011). 3. Methods This study used empirical material which was gathered in a Finnish research and development project, Kunpassi ( ), which aimed to study, develop and educate about well-being at work in the municipal sector. A literature review was done in the project to gather different definitions of well-being at work. Experts in well-being at work and social and health care personnel were interviewed in In addition to the interviews, the social and health care sector participants filled in a paired comparison form. The results presented in this paper are based on the interviews and paired comparison, which were conducted in private and public sector health care and social care organisations. Hence, this study is both qualitative and quantitative in nature. Altogether 15 persons were interviewed, of which seven individually and eight in groups of four persons. One group interview was conducted in a public organisation and the other in a private organisation. The interviewees occupied the following positions: registered nurses (4), practical nurses (2), head nurse (1), physician (1), social worker (1), health care teacher (1), head health care teacher (1) and Bachelors of Social Services specialised in handicapped people s care (4). The organisations varied from housing services to hospitals, health care centres and education institutions. 302

299 In a previous study of the Kunpassi project, the concept of well-being at work was formulated through expert interviews and the results were integrated into a work system framework (Autio et al. 2011; Sinisammal and Kiviniemi 2011). The figures that were created on the basis of these results were utilised in the interviews of this study (Fig 1). First, only the elements of the work system model were showed to the interviewees and they were asked to tell which of these elements have the most (and also the least) effect on well-being at work in the social and health care sector. Secondly, the factors under each element were showed to the interviewees and they were asked to describe which of these factors are important (and not important) in the social and health care sector. At the end of the interviews all the participants filled in the paired comparison form. Paired comparison is a method in which chosen attributes or factors are presented in pairs, all in turn, and the interviewee chooses the more important one from each pair. The results are aggregated into a simple matrix from which the attributes or factors that receive the most choices can be seen (e.g. Kirvesoja and Väyrynen 2001). 4. Results According to the social and health care personnel interviews, the most important element of the work system model was tasks (eight respondents, mostly nurses), and no one called it least important. Instead, technology and tools were thought to be least important by eight interviewees, though two felt they were most important. The reasons for the significance of tasks were the centrality of the patient/customer contact and the meaning it gives to the work. Most social and health care professionals work closely with patients/customers, and they probably feel that successes and problems in their work also influence their well-being at work. The interviewees whose work also included lots of technology (some nurses) found it important, whereas the majority doing non-technical care work thought it was less significant. The more specific factors inside tasks which influence well-being at work were the possibility to influence one s work (13 respondents), success in doing tasks/the patient or customer getting better (10 respondents) and reasonable tasks and clear duties (10 respondents). Most important in technology and tools was that they functioned well ( reliability ) (13 respondents), and in organisation, management and organisation of work in general (all respondents), though many other things mattered, too. The person element s most important factor was motivation (13 respondents), and for work environment, it was safety and security tied with the possibility to work without disturbances (7 respondents for both). The interview and the paired comparison results were analysed together. The elements and factors inside the elements were compared to find out the interrelated order of importance. The results are presented in Figure 2, which works as a preliminary model of the most important factors of wellbeing at work in the social and health care sector. 303

300 INPUT Paired Comparison TECHNOLOGY AND TOOLS Interview 1. Machine safety 1. Reliability, 2. Product safety functionality and usability Paired Comparison ORGANISATION Interview 1. Trust and confidentiality 1. The management 2. Flexibility and organisation in 3. Solidarity, togetherness general and commitment Paired Comparison PERSON Interview 1. Balance between work 1. Motivation and private life 2. Understanding basic tasks and one s own position 3. Attitude toward changes 4. Motivation TASKS ENVIRONMENT (WORK) Paired Comparison Interview Paired Comparison Interview 1. Possibility to influence 1. Possibility to influence work work 2. Sensibility of work 3. Success in work 1. Safe environment 1. Safe and secure 2. Distruption-free environment environment OUTCOMES Wanted Unwanted Figure 2. Most important factors of well-being at work according to the social and health care personnel interviews and paired comparison in the work system model. The terms used in the interview portion differ from the ones in the paired comparison portion because the interviewees didn t see the list of factors during the interviews, thus they used their own words to describe the matter. Some new factors not found in the expert interview result (see Fig. 1) emerged: reliability, functionality and usability. One notable observation was that in the organisation element the interviewees said the most important factor of well-being at work is the management and layout of the organisation itself, but when the same group of people did the paired comparison, management was not among the top three factors. Discussion and conclusions The results showed clearly that the most important element of well-being at work in the social and health care sector was tasks. The interviewees defined it mostly through the patient/customer contact, which has been found central to care work also in other studies (Laine et al. 2011). Tasks were seen to have positive as well as negative effects on well-being at work. In general, the respondents emphasised the positive sides, but also noted the moral and physical load in them. Regarding tasks, they preferred to be able to organise their work quite independently, and the reasonableness of their tasks was considered important. 304

301 The care personnel felt that tasks outside of their training (for example office work not related to care; technical work) were meaningless and stressing. They found that their basic duties (taking care of patients/customers) would not be properly fulfilled if they had to do too many other tasks. This has been observed also in other projects of the research group (Kaikkien käyttäjien sairaala All users hospital 2009). Some new items to be added to the factors of well-being at work emerged in the interviews: reliability, functionality and usability (technology and tools), and the research group decided to add them to the model. In general, the work system model worked well in the interviews and it was easy for the participants to understand. Using the model, well-being at work was considered by the interviewees to be related to all the elements of work without the model some aspects could have been overshadowed. For some respondents the model also functioned as a tool for self-reflection and development ideas, and in the future it could be used this way in work organisations. For the purposes of research, the model helped define well-being at work in the sector in a structured and easily analysable way. If the informants had been only asked to tell the essence of well-being at work, the responses would have been more genuine, but also more difficult to get out and the answers would have been hard to analyse together. The paired comparison method is a good way to determine the order of importance of different factors. However, the method is quite heavy if there are too many factors to be compared. Some participants were clearly distressed when they were filling in the form used in this study. The validity of subjective interviews and their interpretations is always debatable. The paired comparison method was used to increase objectivity. Eventually, the chosen methods showed partly similar results, as Figure 2 points out. However, the number of respondents was low and because of this, the results of this study are suggestive. The interviewees quite broadly represent typical occupations in the social and health care sector. Nonetheless, they still represent more or less individual opinions. In addition, it should be noted that nearly all the participants were women; only one was male. This reflects the fact that about 90 % of the employees in the social and health care sector in Finland are female (Piispa and Hulkko 2009). In the future it would be interesting to study well-being at work with the work system model quantitatively to obtain more generalisable results. Another interesting area of research could be a comparison of different fields of work for example the care sector and one industrial sector. In conclusion, the results of this study could be used, for example, to define the essence of education in well-being at work or the focus areas of management of well-being at work. References Anttonen, H. & Räsänen, T. (eds.) Well-being at work New innovations and good practices. Finnish institute of occupational health, Finland. Autio, T., Jounila, H., Sinisammal, J. & Reiman, A Factors of well-being at work in the work system model. International Conference of Technology Innovation and Industrial Management, June Oulu, Finland. Carayon, P The Balance Theory and the Work System Model Twenty Years later, International Journal of Human-Computer Interaction. 25(5), Carayon, P. & Smith, M Work organization and ergonomics, Applied Ergonomics. (31), Hakanen, J Työn imu ja työuupumus laajennetun työhyvinvointimallin kehittäminen ja testaaminen. Psykologia 37:

302 Kaikkien käyttäjien sairaala [All users hospital. Only in Finnish] Available: Kirvesoja, H. & Väyrynen, S Comparative evaluation of the conjoint analysis and paired comparison methods applied to the design and evaluation of multipurpose chairs. Theoretical Issues in Ergonomics Science (TIES). 1(3), Kunpassi Available: Laine, M., Kokkinen, L., Kaarlela-Tuomaala, A., Valtanen, E., Elovainio, M., Keinänen, M. & Suomi, R Sosiaali- ja terveysalan työolot Kahden vuosikymmenen kehityskulku. Helsinki, Työterveyslaitos Marjala, P Työhyvinvoinnin kokemukset kertomuksellisina prosesseina narratiivinen arviointitutkimus [Experiences on well-being at work as narrative processes - a narrative evaluation study. Only in Finnish]. Doctoral dissertation. University of Oulu, Finland. Piispa, M. & Hulkko, L Työväkivalta on yleistä terveys- ja sosiaalialojen ammateissa. In: Tilastokeskus [Statistics Finland] Hyvinvointikatsaus 3/2009 naiset ja miehet työelämässä. Available: Research on Well-Being at Work in Finland Focusing on Occupational Health and Safety [Only in Finnish]. Reports of the ministry of social affairs and health 2005:25. Helsinki. Sinisammal, J. & Kiviniemi, L Unintentional pilot study Interviewing experts on wellbeing at work. Accepted as conference paper in Nordic Ergonomic Society 2011 Conference. NES Wellbeing and innovations through ergonomics, September Oulu, Finland. Smith, M. J. & Sainfort, P. C A balance theory of job design for stress reduction. International Journal of Industrial Ergonomics. 4, Väyrynen, S Työjärjestelmään ja työvälineisiin liittyvät näkökohdat kuormittavuuden hallinnassa. In: Kantolahti, T. & Tikander, T. (Eds.) Puheenvuoroja työn kuormittavuudesta. Työhyvinvointifoorumi. Sosiaali- ja terveysministeriön selvityksiä

303 E3: SOCIAL & HEALTH CARE E3.1 The affordances of paper, the benefits of digital. Evaluation of citizens' medical documents management practises before and after the use of an electronic Personal Healt Record Enrico Piras E3.2 Heart rate variability in nurses during normal and extended work shifts Susanna Järvelin-Pasanen E3.3 Occupational voice disorders and voice ergonomics - a research survey requested from the Swedish work environment authority Christina Lindhe E3.4 Unintentional pilot study - interviewing experts on wellbeing at work Liisa Kiviniemi 307

304 INTEGRATION OR SUBSTITUTION? EVALUATION OF A PERSONAL HEALTH RECORD Piras, E. M. 1 and Zanutto, A Fondazione Bruno Kessler; ehealth Unit, v. Sommarive 18, Trento (Povo), Italy, 2. Università di Trento; Dipartimento di Sociologia e Ricerca Sociale, v. Verdi 26, 38122, Trento, Italy Personal Health Records (PHRs) are web-based systems that allow patients to access, manage and share health information. In this paper we present the evaluation of the trial of a PHR in a province of northern Italy, which allows citizens to receive documents from health facilities (e.g. lab tests) and to keep a structured health diary. The analysis conducted through semi-structured interviews revealed the emergence of new management practices of the official health documents and a substantial disregard of the functions of a diary, in addition to continued use of information management tools designed by the users. Keywords: Personal Health Record, personal health information management, qualitative research, paper-based records. 1 Introduction Health is a sector where for several decades we have seen the steady-paced introduction of new information and communication technologies (ICTs). Typically, this process involved the creation of electronic tools for professionals (doctors, nurses, clerks). In recent years, however, we have witnessed the development of systems designed to be used by citizens/patients in a logic that would like them to be more and more involved in the processes of prevention, monitoring and care. In this paper we deal with the evaluation of one of these technologies, a Personal Health Record (PHR), a web-based tool that allows patients to access, manage and share medical data produced by health facilities (e.g. medical records, reports about diagnosed medical conditions) but also personal characteristics like age and weight or habits (Markle Foundation 2003; Halamka, Mandl, Tang 2008; Weitzman, Kaci, Mandl 2009). In the last years these patient controlled records have attracted the attention of both the scientific community and the industry for their potential benefits in becoming a key element of new forms of healthcare delivery. In the rhetoric of innovation such tools should enable patient empowerment, increasing awareness about his/her own health whilst supporting him/her in its management. Some recent work (Moen & Brennan, 2005; Unruh & Pratt. 2008; Zanutto & Piras, 2010), however, let us assume that the acceptance and willingness to use new electronic tools can be difficult because in everyday life patients enact complex management practices of health information not easily reproducible through an electronic system. 2 Research context and objectives This work is the first evaluation of a PHR system being tested in a small province in north-east Italy (about ½ million inhabitants). The system was designed and developed from an analysis of health information management practices by citizens which are reported in other works (Piras and Zanutto 2010; Piras et al. 2010). The beta version of the PHR was released in July 2010 for a trial in a context of actual use but on a limited amount of users, according to a logic of testing widely adopted in living labs (Følstad 2008). 308

305 The system consists of a web portal through which users can access a restricted area through a system of strong authentication (one-time password via mobile phone). The system offers user two macro-functionalities. The first is access to all personal documentation produced by public health facilities (e.g. medical reports, laboratory tests, discharge letters) and the ability to add "tags" or "notes" to each document. The second feature is a structured health diary in which to keep track of events, data or personal information (e.g. family clinical history, list of medications taken, selfmeasurement of clinical parameters). For the duration of the trial the 500 system users were guaranteed unmediated access to clinical information produced by health facilities without a medical filter. This has allowed citizens, for example, to have medical reports and laboratory tests at the same time as their general practitioners. People involved in the trial were selected through different channels: members of patients associtions, patitients invited by their general practitioners, people that took part to the pre-design studies and their relatives. The purpose of this first evaluation of the system was to determine if and how people change the existing management practices of health data and how they react to information which is not filtered nor mediated by health professionals. 3 Methods The research was carried on through 15 semi-structured interviews conducted with users who had made the highest number of accesses to the system (detected through the log files on the server). The choice to focus on early adopters of the technology is justified by the desire to understand what are the most attractive features of the system and what directions to take for future development. Respondents were 8 men and 7 women (3 under 35, 4 in the age group between years, 8 over 55). The interview layout was structured to investigate four macro-topics: most commonly used features, moments of intensive use, criticality elements or satisfaction in the use and suggestions on the future development of the system. The interviews (average duration of more than half an hour) were transcribed and the interview layout was used as a preliminary analysis grid. Subsequently, based on the initial analysis, further processing was carried out to highlight some recurring elements: the use of self-produced information management tools and non-use of some features of the system being tested. 4 Results Analysis of the interviews allowed us to observe how, in real-use practices, the PHR has allowed users to go beyond the use assumed by the research team and the development in the design phase and, at the same time, how only some features of the system have actually been used. Furthermore, it has also been noted how the interviewed users have kept management practices of personal health information unchanged using other tools (paper and electronic) with respect to which the PHR went side by side without replacing them. Below we give account of the main results. 4.1 Access to clinical results in real time For all respondents the primary reason for using the system was the ability to view the results of clinical tests quickly without waiting for the mail delivery or collection in person. All users have expressed considerable interest in the fact that the information was readily available online and almost all (14 out of 15) said they carry one or more accesses to the system on the same day of the examination to check if the results were available. A paradoxical effect of the ability to access their own data in real time was manifested in the case of a young interviewee who used the system during a hospital stay to assess (and challenge) the performance of doctors in the department. 309

306 4.2 The PHR to manage and expand the network of carers The possibility of having clinical documents in electronic format has been used by some respondents to convey their information more quickly within their network of clinical care. The availability of paper records alone made their share possible only after some work (e.g., scanning, photocopying, hand delivery) or involved the use of resources not always available (e.g. fax). The immediate availability in electronic format has allowed more rapid sharing with physicians via e- mail (at least with those who accepted this new form of interaction with their patients). This choice was found to be linked to three reasons: to request an opinion to assess the need for a visit, offering a doctor the chance to see the medical tests before a scheduled visit, get a second opinion from a new doctor. Along with these reasons, some respondents said they had shared documents with relatives doctors or nurses to have suggestions or references. 4.3 Use of the system to access medical data in different places One of the system s most popular features was to be able to avoid having folders containing paper documents always with them. Particular appreciation was expressed by respondents with a rich medical history who travel frequently and were used to carry a selection of medical records in order to provide accurate information in case of an emergency. Two respondents, for example, regularly spend part of the year (up to 6 months) in a holiday home and at the beginning of the trial they chose to leave the significant amount of documents that they used to bring with them in the main residence. 4.4 The persistence of other tools of personal health information management The PHR system availability has not substantially changed the habits of the investigators in the production, storage and management of self-monitoring health information. Some users, well before the start of the experiment, equipped themselves with simple tools to support their health condition. For brevity we give the following accounts of two cases in which these tools are either paper (the first) or electronic (the second) Paper-based headache diary One interviewee had created her own "diary of the headache" consisting of a monthly calendar (A4 print from a Microsoft Word calendar) in which, at each day, she kept track of symptoms, events she thought were associated with the onset of pain (e.g. menstrual cycle, patterns of stress) and painkillers taken. The information contained in this paper diary were not shared with her doctor, who was not even aware of this tool, but they were used by the interviewee to keep track of the evolution of pain, to try to understand the factors of the onset and to make decisions regarding her own condition. The diary was kept in the kitchen and used only at the onset of pain. Although the PHR system being tested would allow to enter all the information contained in the paper diary the interviewee chose not to use it, after making an attempt, because of the more cumbersome steps to be performed (must turn on the computer; fields to be filled are not all on the same page, the system does not accept abbreviations which she is accustomed to use). Another reason given for not using the system to replace the paper diary is that the former does not provide a synoptic overview of the trend of the condition for the last period and it is effectively useless as a forecasting tool Computer-based medication scheme manager Following a serious problem, the wife of an interviewee has remained partially disabled and reliant on her husband help for the management of daily life activities and her therapy. This is based on the assumption of a large number of drugs. The respondent, who at the time of the onset of the disease did not have any computer literacy, created over time a basic management tool of medical supplies thanks to a spreadsheet (Microsoft Excel) through which he can quickly extract some information 310

307 about his wife drugs needs used, for example, to know the number of boxes of each product to be prescribed before going on holidays. In this case the user immediately realised the inability to use the PHR system for these requirements. While showing interest in the functionality that lets him keep an updated list of medicines used by his wife, the absence of specific tools for managing the home pharmacy made it impossible to replace the adopted system. Besides, in this specific case, the simple spreadsheet had a symbolic value that transcended the practical usefulness of the system as it represented for the respondent the outcome of learning the use of the computer in an advanced age. 5 Discussion: integration, not substitution The analysis of the interviews showed how people have perceived the PHR system primarily as a useful tool to access and manage medical records produced by health care facilities (e.g. laboratory tests, discharge letters). The availability of the system allowed not only to perform faster some of the tasks usually associated with managing healthcare records (i.e. sharing them with the doctors) but it also gave rise to opportunities to play the patient s role differently (e.g. challenging medical decisions during hospitalization, engaging parents with medical expertise in the network of care). On the contrary the interviewees have not considered the system under evaluation particularly suitable for collecting and managing self-produced information about their health or used for strictly personal objectives. For the latter respondents continued to use systems (paper and electronic) already personally developed and considered best suited to their own needs. A first level of interpretation concerns the radical difference of the recipients of the information contained in various documents. For clinical documents, although the Italian national health system gives citizens the right to have them, the real target audience is physicians and health care institutions. The information is standardized and designed to be viewed by any professional in different settings. It does not come as a surprise, then, that a tool that makes it faster and less costly to receive, access, sort out and electronically transmit may be adopted by users. In other information management tools (e.g. the two shown above), however, the producer and user of information coincide with the patient himself. In this case, the essential elements are not standardizing and speed of transmission but rather the ability to store and display only the data deemed important by the individual user, the easiest thing to achieve on their own rather than in a system designed for the use of a "generic" user. In these personal health-related activities, moreover, the content of information might change over time depending on the circumstances and self-produced information management systems appear to be more flexible and easily adaptable to the situation at hand. The second level of interpretation concerns the practices of use of the various documents. Research has shown that "official medical records" do not belong to the everyday life of the patient, with the exception of the acute phases of illness (e.g. hospitalised patient). This leads to the rarified use of documents and to a management oriented towards the need to share them with medical carers (Zanutto & Piras 2010). The health-related self-produced information, however, are managed favoring their continued accessibility and immediacy of use. The analysis shows that any artifact that requires mediation in labor time of transcription and/or recording of values soon led to the abandonment of automated systems. The materiality of the paper objects, for example, binds very well with the immediacy of their use in data recording practices in which even the powering time of an electronic device or connection to the Internet can be daunting. This also calls into question the level of integration with the places of everyday life. It is no coincidence that some of these selfproduced tools are attached to the refrigerator with a magnet or are in a cabinet in the kitchen. The places, as outlined by our fieldwork, are essential elements to consider in the affirmation of information systems. In conclusion, research has shown that users have regarded the PHR under evaluation as a tool to supplement and not to fully replace their own information resources. This behavior observed in user that took part to the trial shows significant elements of similarity with what occurs in the 311

308 computerization processes in organizational contexts, where we see a persistence of low-tech information systems (e.g. fax, phone, spreadsheets, paper records) next to systems that were designed to replace them (Sellen & Harper 2003). The latter often appear to have a greater ability to support context-specific practices. The overall results provide two stimuli for reflection on the design of patient-centered health information systems to be further explored. The first is the possibility of studying forms of integration between different information management tools, accepting the diversity of needs and being confident in the user's ability to integrate them in a variety of practices with different timing and purposes. The second one is to take advantage of more recently created devices (e.g. smart phones and tablet PCs) that combine portability, ease of access and use and a growing number of applications (apps), often self-produced and in any case easily achievable to support very specific tasks. In both cases the research suggests that personal health information management, at a close look, might reveal to be far too complex to be supported by a single tool, no matter how useful for some specific purpose it might be, but it can benefit from the coordination of different resources. 6 Acknowledgements The present article is a totally collaborative effort. If for academic reason individual responsibility is to be assigned, Enrico Maria Piras wrote the sections Introduction, Methods and Results; Alberto Zanutto wrote Objectives and Discussion. This work is a part of a four-years ( ) research and innovation project TreC (Cartella Clinica del Cittadino) funded by the Department of Health and Social Politics of the Autonomous Province of Trento (Italy) and coordinated by Fondazione Bruno Kessler. This specific research action has been conducted jointly with Sara Mazzoldi of the Graduate School of General Practice of Trento. 7 References Følstad, A Living Labs for Innovation and Development of Information and Communication Technology: a Literature Review. Electronic Journal for Virtual Organizations and Networks, 10, Halamka, J. D., Mandl, K. D. & Tang P. C Early Experiences with Personal Health Records. Journal of American Medical Informatics Association, 15, 1-7. Markle Foundation Connecting for Health. The Personal Health Working Group. Final report. URL accessed 01/05/2008). Moen, A. & Brennan, P. F the Work of Health Information Management in the Household (HIMH): Implications for Consumer Health Informatics (CHI) Innovations. Journal of American Medical Informatics Association, 12, Piras, E. M. & A. Zanutto Prescriptions, X-rays and Grocery Lists. Designing a Personal Health Record to Support (The Invisible Work Of) Health Information Management in the Household. Computer Supported Cooperative Work, 19, Piras, E. M., B. Purin, M. Stenico & S. Forti Prototyping a Personal Health Record Taking Social and Usability Perspectives into Account. In P. Kostkova. Electronic Healthcare, Berlin Heidelberg: Springer, Sellen, A. J., & Harper R. H. R The Myth of Paperless Office. Cambridge, MA: MIT Press Unruh, K. T. & Pratt, W The Invisible Work of Being a Patient and Implications for Health Care: [the Doctor is] my Business Partner in the Most Important Business in my Life, Staying Alive. Conference Proceedings of the Ethnographic Praxis in Industry Conference (EPIC 2008), Copenhagen. Weitzman, E.R., Kaci, L., Mandl, K. D Acceptability of a Personally Controlled Health Record in a Community-Based Setting: Implications for Policy and Design. Journal of Medical Internet Research, 11, URL: 312

309 HEART RATE VARIABILITY IN NURSES DURING NORMAL AND EXTENDED WORK SHIFTS Järvelin-Pasanen, S 1 and Louhevaara, V 1 1 University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Department of Biomedicine, Ergonomics, P.O.Box 1627, Kuopio, Finland The objective of this study was to measure and compare heart rate variability (HRV) in normal and extended work shifts. The subjects were 51 female nurses, who were made two 36-hour HRV measurements with the same recording procedure during normal (mean 8 hours) and extended (mean 13.9 hours) work shifts supplemented with a questionnaire. There were no significant differences in the HRV variables between the normal and extended work shifts. During both work shifts, the sympathetic activation of the autonomic nervous system (ANS) was higher than in leisure and sleep. Key words: Heart rate variability, extended work shift, nursing 1 Introduction Working time patterns have become more diversified, flexible and irregular, and sometimes unhealthy (Härmä 2006). Irregular working times and shift work with long working hours are common in health care (Trinkoff et al. 2006). The work shift with long working hours varies from a normal standard 8-hour shift, for example, to an overtime or extended shift in the work schedule (Trinkoff et al. 2006). In the previous studies, long working hours are associated with cardiovascular disease, self-rated health problems and fatigue (van der Hulst 2003; Caruso at al. 2004). Long working hours are also directly related to the increase of occupational accidents and injuries (Dembe et al. 2005; Dong 2005), and to a higher risk of motor vehicle accidents (Barger et al. 2005). Long working hours are associated with reduced time available for recovery and difficulties to unwind after work (Mejman & Mulder 1998; Härmä 2006). Insufficient recovery disturbs physiological processes such as blood pressure, and increases the sympathetic part of autonomic nervous system (ANS) activity. These lead to physiological and physical health complaints. Long working hours are also associated with unhealthy life-style factors such as a lack of exercise, poor diet, excessive caffeine intake, and increased alcohol consumption and smoking (van der Hulst 2003). Heart rate variability (HRV) reflects the state of the ANS. Thus, the recovery of the ANS can be evaluated by HRV analysis (Task Force 1996). Previous research on HRV at the context of work has focused on the shift work. However, few reports deal with the relationship between HRV and long working hours (Togo & Takahashi 2009). The objective of this study was to measure and compare HRV in normal and extended work shifts. 2 Methods 2.1 Subjects The data were gathered from 60 female nurses. The subjects were volunteers from Kuopio University Hospital. Due to a missing questionnaire or HRV recording, the data of nine subjects had to be excluded from the analyses. The final sample comprised of 51 subjects. They underwent successful HRV recordings in both measurements and their questionnaire data were available. Their 313

310 mean age was 42 (SD 11, range 24-56) years. Their average work experience in their current position was 11 (SD 10, range 0-32) years. No subject had apparent cardiac disease. Almost half of the final sample (44 %) was using at least one medication regularly, but no cardioactive medication. Three of the subjects were regular smokers (average nine cigarettes per day). The subjects filled in a written informed consent form. The study protocols were approved by the Ethical Committee of the Kuopio University Hospital. 2.2 Measurements of HRV The subjects were made two 36-hour HRV measurements with the equal recording procedure. Measurements were carried out during normal and extended work shifts. The heart rate (HR) was measured from each subject with a Suunto Memory Belt HR monitor (www.suunto.com). The recording periods included a morning shift (from 7:00 a.m. to 3:00 p.m.) and an extended work shift (from 7:00 a.m. to 9:00 p.m.). The recording periods started in the evening before the work shift (at 9:00 p.m.) and ended in the morning after the work shift (at 8:00 a.m.). Thus, the recording periods included the night before work shift, the work shift, the leisure time and the night after the work shift. Within the recording period, the subjects were instructed to work in their habitual manner and to maintain their normal life style. In the analyses, the raw HRV data of both measurements were carefully visually verified by the researcher in order to exclude erroneous data. Eight artefact-free 10-min phases from both 36-hour recordings were selected for the analyses of each subject as follows: 1. the beginning of sleep before the work shift 2. the end of sleep before the work shift 3. the beginning of the work shift (between 7:00-8:00 a.m.) 4. during the work shift (between 11:00-12:00 a.m.) 5. the end of the normal work shift and during extended work shift (between 2:00-3:00 p.m.) 6. the end of the extended work shift or during leisure time (between 8:00-9:00 p.m.) 7. the beginning of sleep after the work shift 8. the end of sleep after the work shift One time-domain (RMSSD) and three frequency-domain (LF, HF and LF/HF ratio) HRV parameters were selected for the study. The parameters were selected such that an overall view of HRV in both time- and frequency -domains could be obtained with the minimum number of standard parameters. 2.3 Questionnaire The subjects completed a self-administered questionnaire which included items about individual characteristics (e.g., age, height, weight, social status, regularly used medication, smoking), experience in a current position, sick leaves, and perceived stress. The subjects filled the Work Ability Index (WAI) (Tuomi et al., 1991; de Zwart et al., 2002) and the Maslach Burnout Inventory (MBI) (Schaufeli et al. 1996; Kalimo et al. 2006). 2.4 Statistical analyses Statistical analyses were performed using SPSS (version 14.0 SPSS, Chicago IL, USA), and comprised of descriptive statistics (frequency, mean, standard deviation, ranges) and the analysis according to linear mixed models (Brown and Prescott 2006). The mixed models were used to examine associations between the HRV parameters during the recording period and between measurements. P-values smaller than 0.05 were treated as statistically significant. 314

311 3 Results The mean length of the normal work shift was 8.0 hours and that of the extended shift was 13.9 hours (p=0.000) (Table 1). Table 1. Duration of work shifts and sleep periods. Normal work shift Extended work shift mean (SD, range) mean (SD, range) p a Duration of work shift (hours) 8.0 (0.5, ) 13.9 (0.9, ) Duration of sleep before work shift (hours) 6.6 (1.0, ) 6.8 (1.1, ) Duration of sleep after work shift (hours) 8.4 (1.8, ) 8.0 (1.5, ) a Paired samples t-test There were no significant differences in the HRV parameters between the normal and extended work shifts (Fig. 1 and 2). During both work shifts the sympathetic activation of ANS was higher than during leisure and sleep. This was seen in lower RMSSD and HF values and higher LF values during the work shifts (Fig. 1 and 2) RMSSD values during normal work shift RMSSD values during extended work shift Figure 1. Comparison of RMSSD values between the normal and extended work shifts. The numbers 1-8 means the measurement phases during the 36-hour measurements. 315

312 LFband in normalized units during normal work shift LFband in normalized units during extended work shift HFband in normalized units during normal work shift HFband in normalized units during extended work shift LF/HF power ratio during normal work shift Figure 2. Comparison of frequency domain HRV parameters (LF, HF, LF/HF) between the normal and extended work shifts. The numbers 1-8 means the measurement phases during the 36-hour measurements. 5 0 LF/HF power ratio during extended work shift Discussion and conclusions The main finding of this study was that there were no differences in HRV parameters measured during normal and extended work shifts. The sympathetic activation of ANS was higher during work shifts than during leisure and sleep. This agrees with the previous studies (Togo & Takahashi 2009). During the normal and extended work shifts the variation in the HRV variables of the nurses reflected the large individual variation in the functioning of the ANS. The HRV differences between the work shifts remained unexpectedly small, which may be explained by the adaptation of the nurses to the shift work. Another explanation may be that the nurses had a day off after the extended work shift and no that after the normal work shift. The nurses had a better opportunity to sleep and recover after the extended work shift. A possible explanation may also be that the extended work shifts mean no doubled work duties. On the contrary, works tasks can be organized more flexible which also gives more time to carry out them. The present sample size was quite small. When compared with those in the previous HRV studies (Togo & Takahashi 2009), the final sample size can be considered adequate. These results are obtained from real working conditions, and all intervening factors could not be controlled. Therefore, the results may not be generalized. 316

313 Extended working hours are associated with adverse health, physiological changes and changes in health-related behaviour (van der Hulst 2003). In this study the relationship between extended working hours and HRV was not found. Further research with larger sample sizes and longitudinal study designs are necessary. In particular, follow-up and intervention studies are needed in order to learn more about the HRV responses of different individuals in various work contexts including extended working hours, and about the long-term health consequences of different HRV responses. References Barger, L.H., Cade, B.E., Ayas, N.T., Cromin, J., Rosner, B., Speizer, F.E. & Czeister, C.A Extended workshifts and the risk of motor vehicle crashes among interns. N Engl J Med, 22, Brown, H. & Prescott, R Applied Mixed Models in Medicine. Statistics in practice. Second edition. Wiley, Chichester. Caruso, C.C., Hitchcock, E.M., Dick, R.B., Russo, J.M. & Schmit, J.M Overtime and Extended Work Shifts: Recent Findings on Illnesses, Injuries, and Health Behaviors. U. S. Department of Health and Human Services (DHHS), Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH). Report no Dembe, A., Erickson, J., Delbos, R. & Banks, S The impact of overtime and long work hours on occupational injuries and illnesses: new evidence from the United States. Occup Environ Med, 62, De Zwart, B.C.H., Frings-Dresen, M.H.W. & van Duivenbooden, J.C Test-retest reliability of the Work Ability Index questionnaire. Occup Med, 52, Dong, X Long workhours, work scheduling and work-related injuries among construction workers in the United States. Scand J Work Environ Health, 31, de Castro, A.B., Fujishiro, K., Rue, T., Tagalog, E.A., Samaco-Paquiz, L.P.G. & Gee G.C Associations between work schedule characteristics and occupational injury and illness. International Nursing Review, 57, Härmä, M Workhours in relation to work stress, recovery and health. Scand J Work Environ Health, 32, Kalimo, R., Hakanen, J. & Toppinen-Tanner, S Maslachin yleinen työuupumuksen arviointimenetelmä MBI-GS [The Finnish version of Maslach's Burnout Inventory General Survey]. Helsinki, Finnish Institute of Occupational Health. Mejman, T. & Mulder, G Psychological Aspects of Workload. In Drenth, P.J.D., Thierry, H. & de Wolff, C.J. (eds.) Handbook of work and organizational psychology. Volume 2: Work Psychology, pages Psychology Press, Hove, England. Schaufeli, W.B., Leiter, M.P., Maslach, C. & Jackson S.E Maslach Burnout Inventory - General Survey (MBIGS). In Maslach, C., Jackson, S.E. &, Leiter, M.P. (eds.) Maslach Burnout Inventory Manual, (3 th ed.), pages Consulting Psychologists Press, Palo Alto, CA. Task Force of the European Society of Cardiology the North American Society of Pacing and Electrophysiology Heart Rate Variability. Standards of Measurement, Physiological Interpretation, and Clinical use. Circulation, 93, Togo, F. & Takahashi, M Heart rate variability in Occupational Health A Systematic Review. Industrial Health, 47, Trinkoff, A., Geiger-Brown, J., Brady, B., Lipscomb, J. & Muntaner, C How long and how much Are Nurses now working? Too long, too much, and without enough rest between shifts, a study finds. AJN, 106, Tuomi, K., Ilmarinen, J., Eskelinen, L., Järvinen, E., Toikkanen, J. & Klockars, M Prevalence and incidence rates of diseases and work ability in different work categories of municipal occupations. Scan J Work Environ Health, 17, van der Hulst, M Long work hours and health. Scan J Work Environ Health, 29,

314 318

315 OCCUPATIONAL VOICE DISORDERS AND VOICE ERGONOMICS - A RESEARCH SURVEY REQUESTED FROM THE SWEDISH WORK ENVIRONMENT AUTHORITY. Maria Södersten 1 & Christina Lindhe 2 1 Division of Speech language Pathology, Karolinska Institutet, Stockholm, Sweden. 2 Röstkonsult Christina Lindhe AB, Sweden. Röstkonsult, Lilla Grevegårdsvägen 29, SE Göteborg, Sweden. The purpose was to give an overview on voice production, occupational voice disorders, and the prevalence of voice problems in certain professions such as teachers, personnel in customer contact centres, and artists. Voice ergonomics factors are described, e.g. vocal loading, background noise, room acoustics, stress and posture. It was concluded that voice ergonomics should be included in work environment assessments using a new checklist. There is a need for documentation of long term voice use with portable systems, and for research regarding expenses related to occupational voice disorders, how to limit risks for vocal loading, and for optimal preventive voice care. Key words: voice ergonomics, occupational voice, vocal loading 319

316 Unintentional pilot study Interviewing experts on well-being at work Sinisammal, J. 1, Kiviniemi, L. 2 1 Department of Industrial Engineering and Management, Unit of Work Sciences, P.O.Box 4610, FI University of Oulu, Finland, 2 School of Health and Social Care, Oulu University of Applied Sciences, Department of Oulainen, Kuntotie 2, Oulainen, Finland Twenty experts were interviewed on well-being at work. The results unveiled critical flaws in the question formulation, interview setting and data processing. Consequently, the status of the interviews changed from study to pilot study. The process described in this article illuminates the importance of proper pre-testing of study procedures before committing to a full-scale research. Interview, Well-being at work, Pilot study Introduction and Objectives Due to the drive to continuously improve productivity, more and more work is done by fewer and fewer people than before. Consequently, work in many business areas is becoming more demanding in terms of e.g. rising psychosocial, cognitive, and other requirements. At the same time, the need for longer careers and later retirement is emerging in many post industrial economies. For these reasons, it is important to study which principles, practices, and organizational policies most effectively support well-being at work. Anttonen and Räsänen (2008), from the Finnish Institute of Occupational Health, define well-being at work as safe, healthy, and productive work in a well-led organization by competent workers and work communities who see their job as meaningful and rewarding, and see work as a factor that supports their life management. The objective of the study was to clarify the frame of reference, dimensions, and practical implications of well-being at work by interviewing experts including representatives of both employers and employees in the municipal sector. Methods and Materials Since the researchers already had preliminary, experience-based understanding of well-being at work, interviewing experts was regarded as an adequate method to achieve deeper and broader understanding about the issue (see e.g. Hirsjärvi and Hurme 2010). The starting point for designing the questions was the above-mentioned definition of well-being at work. After several discussions, fifteen questions were formulated. The questions covered topics e.g. occupational health and safety, communication, participation, the role of management and individual worker, and the effect of organisational values. Twenty participants were selected based on their professional and representative experiences from different areas related to well-being at work. Informants included physicians, labour union representatives, occupational safety professionals, teachers and workers safety representatives. Six experts participated in one focus group discussion (e.g. Edmunds 1999), other participants were 320

317 interviewed individually. Five of the interviews were carried out by phone, one by videophone and the rest in a face-to-face setting. The interviews were documented by typing the answers using a laptop computer. Results The answers were classified and grouped into categories based on their similarity. The categories were then named and the emerging views and themes were identified. It soon became evident, that there were several flaws in the interview design. First, some of the questions were too closed and some of the questions were a bit too ambiguous. The questions that were too closed left too little room for unexpected views, opinions, and ideas. On the other hand, some questions seemed to confuse informants and consequently produced only little information about the topic. Just a few questions helped to accumulate relevant information regarding well-being at work. Topics like participation, management support, fluent communication, and clearly defined organizational practices were verbalized. Secondly, typing the answers interfered with the natural flow of discussion and was a bit too slow a method. It is possible, that some comments were not noticed or recorded. Thirdly, the diverse interviewing methods i.e. focus group, face-to-face, videophone and , may have treated participants in an unequal manner, which may have had some influence on the results. In short, the most important findings of the interviews were not related to well-being at work in itself. Instead, the results illuminated different weaknesses of the interview process. This highly valuable and useful information will be utilized in the next round of interviews and is discussed in the last section of this article. Discussion and conclusions As the original objective of the study was not achieved, the above described interviews can be considered as a pilot study for the interviews in the future. Pilot study is a small-scale test or rehearsal phase before committing to a full-scale research. In fact, e.g. Teijlingen et al. (2000) consider pilot study a crucial step in the research process. The goal of a pilot study is to identify all possible flaws and weaknesses of the study protocol, equipment, methods etc. before the actual research gets started. From that point of view, the above described interviews produced highly useful information. One pleasing observation was that, regardless of partially unsuccessful question-formulation, the informants in many cases verbalized more than they were asked to. For example, the question What is the role of personal life management skills in relation to well-being at work was understood as What are the most important personal life management skills in relation to wellbeing at work and why are they important?. Perhaps the most important result from this pilot study was the improved understanding regarding question formulation. As the closed questions produced little information, the next round of interviews will most likely be grounded on relatively wide topics. The results of the pilot study will help to formulate the questions for the next round in such way, that they inspire and motivate the future participants to do their best. Based on these experiences, it seems reasonable to record all the interviews for later analysis and carry out all the interviews in a standardized face-to-face setting. References Anttonen, H. & Räsänen, T. (eds.) Well-being at Work New Innovations and Good Practices. Finnish Institute of Occupational Health, Finland Edmunds, H. (1999) The Focus Group Research Handbook. 321

318 Hirsjärvi, S. & Hurme, H. Tutkimushaastattelu: Teemahaastattelun teoria ja käytäntö. Helsinki: Gaudeamus Helsinki University Press, Van Teijlingen, E. R., Rennie, A.-M., Hundley, V. and Graham, W. The importance of conducting and reporting pilot studies: the example of the Scottish Births Survey. Journal of Advanced Nursing, 34(3), Blackwell Science Ltd,

319 F3: DESIGNING AND ORGANISING FOR ALL F3.1 Environmental risk factors and school injuries Simo Salminen F3.2 Accommodating working conditions of persons with disabilities or long-standing health in the open labour market Nina Nevala F3.3 Use of computers, programs and assistive technology among people with disabilities Kirsi Jääskeläinen F3.4 Signs "for All" analysis toolkit for the communication systems of pulic spaces Giuseppe Di Bucchianico 323

320 ENVIRONMENTAL RISK FACTORS AND SCHOOL INJURIES Salminen, S. 1, Kurenniemi, M. 2, Lounamaa, A. 3, Råback, M. 3 & Markkula, J. 3 1 Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI Helsinki, Finland 2 National Research and Development Centre for Welfare and Health, Helsinki, Finland 3 National Institute for Health and Welfare, Helsinki, Finland Although injuries at school are an important issue in public health, environmental factors in schools have seldom been the focus of school injury research. Nine comprehensive Finnish schools registered school injuries over a period of two school years. A total of 722 injuries were classified. In 11.6% of these injuries, the physical environment factor was evident, and in 28.1% of the injuries, physical environment was suspected of being a contributory risk factor. In this study ice on the ground was mentioned most frequently as an environmental risk factor. An initiative has been launched on a mandatory wintertime master plan. Keywords: School injury, School yard, Ice, Snow, Winter 1 Introduction Children spend a considerable part of their waking hours at school: in Germany as much as 50% (Kraus et al. 2006). In Finland, children between 10 and 14 years of age spent an average of 2 hours and 22 minutes in schools every work day (Statistics Finland, 2008). Safety at schools is thus an important factor for public health. Injuries at school are more common among boys than girls (Di Scala et al. 1997; Haq and Haq 1999; Li et al. 2003). However, girls are nearly twice as likely to be injured as boys at the school playground (Boyce et al. 1984a). In French schools, girls were injured during sports and physical training more often than boys (Chau et al. 2007). Playgrounds exceeded all other sites of school injury for all age groups (Haq and Haq 1999). However, playground injuries were more frequent in elementary schools or kindergartens than in secondary schools (Laflamme et al. 1998) For instance, injury-risk situations occurred every three minutes among schoolchildren playing in a New England school playground. Boys were involved in these situations more often than girls, and were more likely to perform aggressive actions (Coppens and Gentry 1991). The injury rate at playgrounds was more than twice that of sports areas among, for example, Vancouver elementary school students (Sheps and Evans 1987). Fractures also occurred most often at playgrounds among elementary school children in Seattle (Johnson et al. 1972), as did almost half (42%) of school injuries in Alexandria, Egypt (Kamel et al. 1998). In Greek schools, playgrounds were dry during the occurrence of 74% of injuries, and the playground was covered by asphalt in 29% of cases (Christoforidis and Kambas 2007). Head injuries were more frequent at the playground, whereas injuries to the lower and upper extremities were most frequent during sports (Laflamme and Menckel 1997). There was a difference of up to 40 times in rates of equipment injury between schools (Boyce et al. 1984b). Playground equipment caused 38% of all playground injuries 324

321 (Lenaway et al. 1992), and the injury rate in Utah school playgrounds covered by asphalt was six times higher than that of those covered by sand (Sosin et al. 1993). Breaks and physical education lessons are school time which is spent on school grounds including playgrounds. A total of 85% of injuries in Swedish schools occurred during breaks and physical education (Schelp et al. 1991), which together comprised about one-third of school time (Hammarström and Janlert 1994). The rate of injuries was also slightly higher in unorganized play or free time than during organized athletic programs in Hawaiian schools (Taketa 1984). In Poland, 37% of school injuries for pupils aged 7-15 years occurred during breaks and 33% during physical education (Sosnowska and Kostka 2003), while in Germany, 47% of school injuries were related to sports, 30% to playtime and 17% to classroom lessons for all school-aged (Scherer et al. 2006). Wintertime in Finland (December to February) is the most critical time period for school injuries. A previous study in the Turku region in Finland shows that most school injuries occurred in October and November and from January through March (Sillanpää et al. 1983). This study revealed that the first ice storm before the real winter was also a critical time for injuries due to falls. As the literature review showed together with activity, environmental factors are important potential causes of school injuries. However, the contribution of environmental factors to school injuries has not been studied yet except studies with playground equipments (Boyce et al. 1984b) and school environment checks in Sweden (Laflamme and Eilert-Petersson 1998). The aim of this study was to examine the role of environmental factors in school injuries in Finland. This is done from the viewpoint of architecture, which means that the physical and built environment is the focal point. The built environment included playgrounds, its equipment, the floor and playground cover, but not machines, balls and moving equipment. It means also that school environment is looked at the point of planning. 2 Materials and methods As a part of a larger project on school injuries in Finland (Salminen et al. 2008), nine comprehensive schools from four Finnish cities registered injuries. The total number of pupils was 2900 and their age ranged from 7 to 15. The schools participated in this study on a voluntary basis and registered injuries over a period of two school years: and All injuries in which an injury pupil required the treatment of school nurse were included. An 'injury at school' was defined as either an intentional or unintentional injury that caused physical harm to the pupil. A teacher or school nurse filled in a school injury form (one A4 page) immediately after the injury, based on the injured pupil's report. The form was completed for both injuries and violent acts, and the average time required to fill the form was two minutes. The form was same for all of the schools. The school injury form included a space for short description of the injury. During initial meetings with school staff and school nurses, researchers discussed how to write descriptions. The classification of the injuries as environmental factor, a suspected environmental factor, or a non-environmental factor as a cause is based on these written descriptions. The classification was carried out by two researchers independently (MK, SS). The classification reliability was estimated by the consensus of the results of these two independent classifications. Their consensus based on the sample of 100 observations was 81.2%, 325

322 which is above the acceptable level of 70% (Litwin 1995). Secondly, the reliability of classification was measured by Cohen's coefficient of kappa (Revelle 1990). Its value was 0.50 (95% CI ) which was moderate agreement. In the case of inconsistency between classifier, the result of the main classifier (MK) was used. An injury was classified as having been caused by an environmental factor where the effect of the environment was obvious and could be estimated to be the main reason for the injury occurrence: For example, pupil stepped on a door holder and fell. A suspected environmental factor concerned injuries in which the environmental factor was seen as a contributing factor but not an immediate cause: For example, the narrowness of a corridor contributing to the collision of pupils, causing injury. If the school environment has been different kind, the school children should behave in safe way in the situations where the injuries happened. Other injuries were classified as: No definite evidence that the environmental played a major role. 3 Results Over half of the injuries recorded in the registry occurred during breaks, and one out of four injuries during sports lessons. Boys were injured more often during breaks, whereas girls sustained injuries more often during sport lessons (Salminen et al. 2008). Almost half (49%) of school injuries occurred outdoors. A total of 722 injury forms were classified. In 11.6% of classified injuries, a physical environment factor was evident, and was estimated to be the most significant factor contributing to the occurrence of the injury. In 28.1% of the injuries, the environment was considered an important and contributory risk factor. Thus the school environment was a contributing factor in 39.7% (287) of school injuries. Table 1 shows the distribution of environmental factors in school injuries. One third of injuries were caused by slippery surfaces. School yard arrangements contributed to one fifth of injuries. Every 12th injury occurred in traffic environment. Other environmental factors had minimal influence on injuries. The following injuries are examples of a clear environmental factor: "A pupil fell down the stairs outside" (injury number 197), and "A pupil slipped and fell on his/her right hand" (injury number 431). Table 1. Environmental factors related to school injuries Factor Frequency % Typical injury Door Pinched fingers in the door Chair Coming down with a chair Window Sway and window get broken Floor Tumbled down on the roughness floor Steps, handrails Falling on steps with bad condition Playgrounds Get a piece of glass from playground Equipments, slides Jump over bicycle stand and injured his knee Traffic arrangements Crash with bicycle to a car School yard arrangements Fall by sand on the asphalt Space arrangements Fall on the bench of the corridor Slipping Slipping and falling during the play 326

323 Slippery Slipping on icy school ground Others Football hit to student's forehead Total An example of a contributing factor is: "A pupil rode his/her bicycle to the end of the asphalt and fell" (injury number 720). Another injury where the environment was a contributing factor is: "A pupil's left shoulder rubbed against the railing in the swimming pool causing a bruise" (injury number 643). Ice was the most frequently mentioned environmental factor (in 5.8% of injuries) associated with school injuries in the school yard. For example: "A pupil fell on the icy school ground, breaking one front tooth and splitting a lip" (injury number 42). 4 Discussion One of the main conclusions of this study is that in Finland, the architecture of school yards and playgrounds are designed for the summertime, and are not suitable during wintertime, when there is snow and ice on the ground. This explains why there are so many falls in Finnish schools. Finnish children have long summer vacations, from June to mid-august, and attend school during the winter months. The snow and icy season varies depending on the location of the school: In southern Finland, the season is on average from November to March, whereas in the north it lasts from October to April. Maintaining school yards during the winter months, recognizing ice as a significant risk factor, following the weather forecast for icy days, and passing on this information to maintenance personnel, could reduce school injuries in countries such as Finland. The results of this study led to a mandatory wintertime master plans for school yards in Finland. Rigorous, effective injury-prevention efforts at school should address several factors: the environment, individual behavior, social norms, legislation, and policy. Improvements to the physical environment of the school through regular safety assessments, good quality maintenance, and repairing hazards immediately after they are identified, can contribute to school safety. To tackle these challenges, attention should be paid to both organizational and everyday routine practices in schools. In this way, we can guarantee children's rights to a safe environment - a safe school environment. Environmental modification and increased supervision can reduce school injuries (Josse et al. 2009). However, increased teacher supervision not necessarily help to prevent injuries, as 88% of injuries at Missouri schools, for instance, occurred while pupils were allegedly supervised by adults (Dale et al. 1969). On the other hand, a playground prevention plan (Olsen et al. 2008) could modify the school yard safer. 5 References Boyce, W.T., Sprunger, L.W., Sobolewski, S. & Schaefer, C. 1984a. Epidemiology of injuries in a large, urban school district. Pediatrics,74,

324 Boyce, W.T., Sobolewski, S., Sprunger, L.W. & Schaefer, C. 1984b. Playground equipment injuries in a large, urban school district. American Journal of Public Health, 74, Chau, N., Prédine, R., Aptel, E., d Houtaud, A. & Choquet, M School injury and gender differentials: a prospective cohort study. European Journal of Epidemiology, 22, Christoforidis, C. & Kambas, A Childhood injuries in Greek school environment. International Journal of Injury Control and Safety Promotion, 14, Coppens, N. M. & Gentry, L. K Video analysis of playground injury-risk situations. Research in Nursing & Health, 14, Dale, M., Smith, M. E. M., Weil, J. W. & Parrish, H. M Are schools safe? Analysis of 409 student accidents in elementary schools. Clinical Pediatrics, 8, Di Scala, C., Gallagher, S. S. & Schneps, S. E Causes and outcomes of pediatric injuries occurring at school. Journal of School Health, 67, Hammarström, A. & Janlert, U Epidemiology of school injuries in the Northern Part of Sweden. Scandinavian Journal of Social Medicine, 22, Haq, S. M. & Haq, M. M Injuries at school: a review. Texas Medicine, 95, Johnson, C. J., Carter, A. P., Harlin, V. K. & Zoller, G Injuries resulting in fractures in the Seattle public schools during the school year Journal of School Health, 42, Josse, J. M., MacKay, M., Osmond, M. H. & MacPherson, A. K School injury among Ottawa-area children: A population-based study. Journal of School Health, 79, Kamel, M. I., Youssef, R. M., Teleb, N. A. & Atta, H. Y Epidemiology of school injuries in Alexandria. Journal of the Egyptian Public Health Association, 73, Kraus, R., Heiss, C., Alt, V. & Schnettler, R Schulunfälle - eine Analyse von Verletzungsmustern und Behandlungsaufwand. Zentralblatt für Chirurgie, 131, Laflamme, L. & Eilert-Petersson, E School-injury patterns: A tool for safety planning at the school and community levels. Accident Analysis and Prevention, 30, Laflamme, L. & Menckel, E School injuries in an occupational health perspective: what do we learn from community based epidemiological studies? Injury Prevention, 3, Laflamme, L., Menckel, E. & Aldenberg, E School-injury determinants and characteristics: Developing an investigation instrument from a literature review. Accident Analysis and Prevention, 30,

325 Lenaway, D. D., Ambler, A.G. & Beaudoin, D. E The epidemiology of school-related injuries: New perspectives. American Journal of Preventive Medicine, 8, Li, L.-P., Wang, S., Huang, G. & Luo, J.-Y A survey on injury incidence in school children in Shantou City, China. Biomedical and Environmental Sciences, 16, Litwin, M. S How to measure survey reliability and validity. Thousand Oaks, CA: Sage. Olsen, H. M., Hudson, S. D. & Thompson, D Developing a playground injury prevention plan. Journal of School Nursing, 24, Revelle, W Procedures for personality and psychological research. Evanston: Northwestern University. Available at: edition. Salminen, S., Lounamaa, A. & Kurenniemi, M Gender and injury in Finnish comprehensive schools. Accident Analysis and Prevention, 40, Schelp, L., Ekman, R. & Fahl, I School accidents during a three school-years period in a Swedish municipality. Public Health, 105, Scherer, K., Mausner-Dorsch, H. & Kemény, P Surveillance-based injury epidemiology in schools in Germany. International Journal of Injury Control and Safety Promotion, 13, Sheps, S. B. & Evans, G. D Epidemiology of school injuries: A 2-year experience in a municipal health department. Pediatrics, 79, Sillanpää, M., Terho, P., Westerén, H. & Pisirici, H Accidents in schoolchildren: epidemiologic, aetiologic and prognostic considerations. Acta Paediatrica Hungarica, 24, Sosin, D. M., Keller, P., Sacks, J. J., Kresnow, M.-J. & van Dyck, P.C Surface-specific fall injury rates on Utah school playgrounds. American Journal of Public Health, 83, Sosnowska, S. & Kostka, T Epidemiology of school accidents during a six school-year period in one region in Poland. European Journal of Epidemiology, 18, Statistics Finland Ajankäyttötutkimus [A time use survey in Finland ]. Tilastokeskuksen PX-Web-tietokannat. Date Taketa, S Student accidents in Hawaii's public schools. Journal of School Health, 54,

326 ACCOMODATING WORKING CONDITIONS OF PERSONS WITH DISABILITIES OR LONG-STANDING HEALTH PROBLEMS IN THE OPEN LABOUR MARKET Nevala, N 1, Kalliomäki-Levanto, T 1, Jääskeläinen, K 1, Pekkarinen, A 1 and Elo, J 2 1 Finnish Institute of Occupational Health, Helsinki, Finland 2 The Social Insurance Institution of Finland The aim of this study was to determine what accommodating solutions have been introduced into the work content and working conditions of persons with disabilities in the open labour market. Most of the implemented work accommodations dealt with worktime, possibilities to affect the work or self, and the measurements and functionality of the workstation. Of the different disability groups, the workers with visual impairments had had more accommodations made in their workstations. Accommodating working conditions and flexible work organisation makes it possible to work in the open labour market regardless of a limited work ability. Keywords: Accomodation, Accessibility, Disability, Ergonomics 1 Introduction The European Union approach to disability demands the elimination of discrimination and a determination that people with disabilities should have the same rights as nondisabled people (European Comission 2010). The EU perceives disability essentially as the result of the dynamic interaction between a person with impairment and his or her environment. Persons with permanent physical disabilities should have possibilities to continue working with a permanent disability or a disease by means of workplace accommodations and the use of aids (Schneider and Young 2010; Solovieva et al. 2010). Information technology and, especially, assistive devices and programs enable people with disabilities to work (Springer and Siebes 1996; Mauri et al. 2006; Chen et al. 2007). However, only few accommodations have been carried out at work of physically disabled employees in Finland (Nevala-Puranen et al. 1999). Ten Katen et al. (2011) showed that work-oriented interventions at preventing postpoliomyelitis syndrome patients from dropping out of the workforce should primarily focus on reducing physical job demands, arranging adaptations in the workplace and increasing job control. As reported by the employers, the most frequently mentioned direct benefits from implementing workplace accommodations were (a) retained a qualified employee, (b) increased worker productivity, and (c) eliminated the cost of training a new employee (Solovieva et al. 2010). According to Solovieva et al. (2009) many workplace accommodations cost nothing to the employer (e.g., changing the work schedule, moving the individual to another location). 2 Objective The aim of this study was to determine what accommodating solutions have been introduced into the work content and working conditions of persons with disabilities or long-standing health problems in the open labour market. The theoretical orientation quiding this study was the ICF model (World Health Organisation 2001) (Figure 1). 330

327 Health condition Body functions, structure Activity Participation Environmental factors Personal factors Figure 1. Interactions between the components of the International Classification of Functioning, Disability and Health (ICF) (World Health Organisation 2001) 3 Materials and methods 3.1 Participants A total of 205 persons 16 years of age or older (74% female, 26% male) who received support for a disability from The Social Insurance Institution of Finland and worked in the open labour market took part in the study. The median age of the research group was 50 years. The participants had a physical, visual, or hearing disorder or a communi-cation problem (Table 1). One quarter (27%) of the respondents were born disabled, and the rest had become disabled or were injured later. One in four (23%) reported that they had a master's degree from a university. Over half (53%) of the respondents had passed their matriculation examination, one-third (33%) had attended a comprehensive school, and 14% had elementary school as their basic education. Most (81%) of the participants held permanent positions and less than half worked parttime. The biggest fields of employment were health care and social services (28%), education (12%), and public administration (12%). 3.2 Methods This was a descriptive cross-sectional study. The research was carried out using the internet-based data collection and feedback management software of Digium Enterprise. 331

328 Table 1. Type of disabilities reported by the respondents (n=205). The same person can belong to several groups. Type of disability n % Physical disability Visual impairment Hearing impairment Communication problem Learning disability Results The workers with a disability or a long-standing health problem were more enthusiastic about their work (p<0.0001) than Finnish wage-earners in general. Half of the subjects said that their working spaces were not functional or practical with respect to the dispatch of their job. Most of the implemented work accommodations dealt with worktime, possibilities to affect the work or self, and the measurements and functionality of the workstation (Table 2) (Figure 2). Of the different disability groups, the workers with visual impairments had had more (p=0.002) accommodations made in their workstations. Fewer than one third (27%) of the respondents were especially familiar or familiar with aids and computer programs that made the use of a computer easier. Every tenth (9%) of the respondents used an electrically adjustable workstation. Fewer than one third (29%) of the respondents reported that their employer had paid for the accommodations made in their working conditions. The costs of the accomodations were mainly below 1000 to the employer (Table 3). The labour administration provided funds for setting up the working conditions of 6% of the respondents, and 7% of the employers had received wage support. The workers for whom sufficient accommodations had been made in their working conditions felt that their work ability was better than the others (p=0.0036). They also had a better opportunity for social support, equal treatment, work management and development, and participation in the work done at their workplaces. These workers also felt that the cooperation between their employer, occupational health professionals, and rehabilitation professionals functioned better (p=0.0016). Figure 2. The implemented physical accommodations, i.e., an electrically adjustable workstation, among the workers (n=205) with disabilities. 332

329 Table 2. The most typical (%) workplace accomodations among the workers with disabilities (n=205). Type of workplace accomodation % Worktime 45 Possibility to adjust the work 41 Ergonomics of the workstation 40 Work tasks 40 Getting help 38 Accessibility of occupational health services 35 Tools, machines, and devices 34 Work posture 29 Amount of the work 28 Parking facilities 25 Table 3. The costs of workplace accomodations paid by employers among the workers with disabilities (n=50). Costs of accomodation n % < euro euro euro 2 4 > euro 2 4 Fewer than half (47%) of the respondents reported that the occupational health services (OHS) familiarised itself with the worker s work and workstation in conjunction with a workplace survey. Furthermore, 20% of the workers with disabilities said that their special needs are well known in their OHS. Half (54%) of the workers said, that their OHS had given no recommendations concerning their work. The recommendations given by OHS concerned mainly the accomodations of the personal workstation. The sufficiency of the workstation accomodations was the best among the workers with visual impairments (Figure 3). The OHS had seldom used the services of occupational physiotherapists, disability foundations or rehabilitation personnel in the processes of the workplace accomodation. 333

330 Physical disability n= Visual impairment n= Enough Hearing impairment n= Too little Communication problem n= No need/cannot say 23 Other disability n= Figure 3. Sufficiency of the workstation accomodations made among the workers (n=205) with different disabilities 5 Discussion This study determined what accommodating solutions have been introduced into the work content and working conditions of persons with disabilities or long-standing health problems in the open labour market. The research was carried out using the internet-based data collection and feedback management software of Digium Enterprise. This was a rapid and suitable method for workers with disabilities who mainly use a computer at work. The workers with disabilities were more enthusiastic about their work than Finnish wage-earners in general. This result is important when the possibilities to continue working with a permanent disability or a disease will be enhanced. According to this study, computer use is commoner among disabled people than among workers in Finland in general. It is obvious, that more knowledge is needed about workplace accomodations and assistive devices that enable people with disabilities to work. Half of the workers said, that their OHS had given no recommendations concerning their work. The preparedness of OHS to support persons with disabilities or long-standing health problems should be improved. It is obvious, that the services of occupational physiotherapists, disability foundations and rehabilitation personnel should be more readily used in the processes of the workplace accomodation. The acquisition processes used to access assistive technology should be more consistent and better known by everyone involved. Whereas it is obligatory for visually handicapped people to use adaptive technology, it is also highly recommendable to increase its use among other disability groups. Cooperation is necessary between employers, employees, OHS, and information technology management, for example, in acquiring the assistive technology for computerized work. In conclusion, accommodating working conditions and flexible work organisation makes it possible to work in the open labour market regardless of a limited work ability. The accommodations found to benefit workplaces can be used more broadly for partially disabled persons, as well as to lengthen the career of older workers. 334

331 6 References Chen, H.-C., Liu, Y.-P., Chen, C.-L. & Chen, C.-Y. (2007). Design and feasibility study of an integrated pointing device apparatus for individuals with spinal cord injury. Applied Ergonomics, 38, European Comission (2010). Standardisation mandate to CEN, CENELEC AND ETSI to include "Design for all" in relevant standardisation iniatitives Ref. Ares (2010) /09/2010. Mauri, C., Cranollers, T., Cores, J. & Garcia, M. (2006). Computer vision interaction for people with severe movement restrictions. Human Technology, 2, Nevala-Puranen, N., Seuri, M., Simola, A. & Elo, J. (1999). Physically disabled at work: Need for ergonomic interventions. Journal of Occupational Rehabilitation, 9, Solovieva, T.I., Walls, R.T., Hendricks, D.J. & Dowler, D.L. (2009). Cost of workplace accommodations for individuals with disabilities: with or without personal assistance services. Disability and Health Journal, 2, Solovieva, T.I., Dowler, D.L. & Walls, R.T. (2010). Employer benefits from making workplace accommodations. Disability and Health Journal, in press. Springer, J. & Siebes, C. (1996). Position controlled input device for handicapped: Experimental studies with a footmouse. International Journal of Industrial Ergonomics, 17, Ten Katen. K., Beelen, A., Nollet, F., Frings-Dresen, M.H. & Sluiter, J.K. (2011). Overcoming barriers to work participation for patients with postpoliomyelitis syndrome. Disability Rehabilitation, 33, World Health Organisation (2001). ICF. International Classification of Functioning, Disability and Health. Geneva,

332 USE OF COMPUTERS, PROGRAMS AND ASSISTIVE TECHNOLOGY AMONG PEOPLE WITH DISABILITIES Jääskeläinen Kirsi, Kalliomäki-Levanto Tiina, Pekkarinen Anneli, Nevala Nina Finnish Institute of Occupational Health, Helsinki, Finland Information technology and, especially, assistive devices and programs enable people with disabilities to work. The aim of this study was to determine the knowledge and use of information technology among workers with disabilities in the open labour market. One fourth (27 %) of the participants considered their knowledge of assistive technology to be very good or good, whereas 39% considered their knowledge to be very poor or poor. Workers with visual disorders had the best awareness of assistive technology in computer work. Over half of the respondents indicated that the user interface, display screen, and mouse settings of their computers were not accommodated. Keywords: Information technology, Assistive devices, Disability, Employment 1 Introduction Information technology and, especially, assistive devices and programs enable people with disabilities to work (Chen et al., 2007). The commonest desktop and web-based applications appear to contain some usability problems that have an impact on blind users who are using screen readers and keyboards to navigate them, for example, navigation, tab order, contacts, and calendaring (Wentz and Lazar, 2011). Accordingly, many of the discovered problems could be addressed through relatively minor modifications such as tab order, labelling, terminology, clear confirmation, and the placement of buttons on an interface. Mice and other pointing devices are replacing traditional computer input keyboard tasks as a result of extensive window and graphic user interfaces in computer operation systems. People with severe disabilities typically encounter mouse operation problems (Rao et al., 2000). Chen et al. (2007) have developed an integrated pointing device that integrates numerous commercial pointing devices, thereby providing the possibility for some people with a physical disability to obtain computer operability. Keates et al. (2007) reported that people with cognitive and learning difficulties need training that is tailored to their needs. In addition, they found that dyslexics often benefit from having visual or aural representations of the training materials, rather than textual ones. Increasing evidence shows that Web sites that eschew guidelines for dyslexic accessibility not only undercut the esteem and success of dyslexic users, but also affect their non-dyslexic counterparts (McCarthy and Swierenga, 2010). 2 Objective The aim of this study was to determine the use of, knowledge of, and user satisfaction with information technology among workers with disabilities in the open labour market (Figure 1). 336

333 Figure 1. A visually impaired employee using a magnifying device and software 3 Materials and methods 3.1 Participants A total of 205 persons 16 years of age or older (74% female, 26% male) who received support for a disability from The Social Insurance Institution of Finland and worked in the open labour market took part in the study. The median age of the research group was 50 years. Over half (53%) of the respondents had passed their matriculation examination, one-third (33%) had attended a comprehensive school, and 14% had elementary school as their basic education. One in four (23%) reported that they had a master's degree from a university. The biggest fields of employment were health care and social services (28%), education (12%), and public administration (12%). Most (81%) of them had permanent work, 10% were employed part-time, and 3% worked as an entrepreneur. The participants had a physical, visual, or hearing disorder or a communication problem (Table 1). One quarter (27%) of the respondents were born disabled, and the rest had become disabled or were injured later. The types of physical disability varied, including walking impairment, muscular impairment, joint mobility impairment, general deterioration, upper-limb dysfunction, balance impairment, and coordination disorders. One quarter reported that they had a visual impairment, for example, weak eye sight or otherwise deteriorated sight. One fifth of the respondents reported that their hearing had deteriorated, for example, they were hard of hearing, deaf, or had had an inner ear implant. 337

334 Table 1. Type of disabilities reported by the respondents (n=205). The same person can belong to several groups. Type of disability n % Physical disability Visual impairment Hearing impairment Communication problem Learning disability Methods This was a descriptive cross-sectional study. The research was carried out using the internet-based data collection and feedback management software of Digium Enterprise. Three disabled persons who did not belong to the research group debugged the inquiry. The inquiry was developed according to their opinions. A case study was carried out as part of this project, which concerned accommodating solutions for blind workers (Bruseberg and McDonagh-Philp, 2002). 4 Results The workers with disabilities used a computer at work more than Finnish employees in general. Over half (59%) of the respondents used a computer over 4 hours a day. Most (75%) had a desktop computer, and every fifth (22%) had a laptop. Mobile phones were used by 6% of the workers with disabilities. Most of the workers (72%) used office computer programs involving word processing, spreadsheets, or presentation graphics (Table 2). Table 2. The most typical computer tasks of the persons with disabilities (n=205). Computer tasks n % Office programs (word processing, spreadsheet or presentation graphics) Design, image processing Programming, web development 9 4 Customer service (directly or by phone) Use of monitoring systems Control of technical and medical devices 4 2 Other tasks One fourth (27%) of the participants considered their knowledge of assistive technology to be very good or good, whereas 39% considered their knowledge to be very poor or poor. The workers with visual disorders had the best awareness of assistive technology in computer work. The participants seldom used devices that facilitate computer work. Most of the workers with disabilities (66%) did not use a trackball, ergonomically shaped mice, or mouse trappers. Over half of the respondents indicated that the user interface, display screen, and mouse settings of their computers were not accommodated (Table 3). Assistive devices and software were used the most often by workers with visual impairments (Table 4). The most typical assistive devices were screen reader software, speech synthesizers, and magnifiers. 338

335 Table 3. Accommodations made to the computer user interface of disabled workers (n = 205). User interface accommodation n % Display settings Settings of the mouse and its pointer Magnification of the text and icons Accessibility options 16 8 Keyboard settings 15 7 None Other 7 3 Table 4. Visual aids of persons (n=205) with a disability. Visual aid n % Spectacles Magnifying lens, binoculars, portable magnifier Absorption glasses 7 3 Closed circuit television/magnifying camera 6 3 Screen reader or magnifying software Speech synthesizer 7 3 Scanner and OCR software 3 1 Screen reader or speech software for a mobile phone 3 1 DAISY listening and dictating device 13 6 Extra lighting 18 9 White cane 11 5 Other visual aids 7 3 OCR = optical character recognition Case study: A physician with a visual impairment One blind specialist physician used a great deal of assistive computer technology. Firstly, she scanned documents using a scanner and OCR (optical character recognition) software to be able to listen to the text on the computer screen with the use of Jaws Screen Reading software. She listened to audio books with a Daisy dictating and listening device. The display and keyboard settings were also modified. Her personal assistant worked as her PC (personal computer) aide. When she lost her reading sight, the vision centre of the local hospital recommended that she acquire assistive technology to help her in her computer work. It was also recommended that she 339

336 contact the Finnish Federation of the Visually Impaired (FFVI). Firstly, The Social Insurance Institution of Finland underwrote her purchase of a computer and scanner for her home use. The computer hardware and software were furnished by her employer. When the new visual patient information system was phased in, it became essential for her to obtain a personal assistant to help her with her computer work. The workplace accommodations in the computer technology and a personal assistant made it possible for her to continue to work as a specialist physician. 5 Discussion According to this study, computer use is commoner among disabled people than among workers in Finland in general. It was found that workers with disabilities primarily used desktop computers. This trend can be due to the difficulty of transferring a laptop during the commute to and from work. The use of mobile phones and communicators was rare; only 6% of the disabled workers used them. The usability of small devices is known to be poor in many cases. It is positive that the employer had acquired computers for most (85%) of the participants. One third of the respondents said that they knew assistive technology well. However, the respondents knowledge of mainstream technology that supports the use of a computer was rare. More accommodations should be made in computer work among workers with disabilities. Cooperation is necessary between occupational health care, information technology management, and computer experts, for example, in acquiring the assistive technology needed by disabled workers. The acquisition processes used to access assistive technology should be more consistent and better known by everyone involved. Whereas it is obligatory for visually handicapped people to use adaptive technology, it is also highly recommendable to increase its use among other disability groups. For example, people with learning difficulties would benefit from the use of screen readers. It is important to note that computer techniques that are usable by disabled people are also usable, and can help, the work of every one of us. In conclusion, more knowledge is needed about assistive devices and programs that enable people with disabilities to work in the open labour market. 6 References Bruseberg, A. & McDonagh-Philp, D Focus groups to support the industrial/product designer: a review based on current literature and designers feedback. Applied Ergonomics; 33: Chen, H.-C., Liu, Y.-P., Chen, C.-L. & Chen, C.-Y Design and feasibility study of an integrated pointing device apparatus for individuals with spinal cord injury. Applied Ergonomics, 38, Keates, S., Adams, R., Bodine, C., Craja, S., Gordon, W., Gregor, P., Hacker, E., Hanson, V., Kemp, J., Laff, M., Clayton, L., Pieper, M., Richards, J., Rose, D., Savidis, A., Schultz, G., Snayd, P., Trewin, S. & Varker, P Cognitive and learning difficulties and how they affect access to IT systems. Universal Access in the Information Society, 5, McCarthy, J.E. & Swierenga, S.J What we know about dyslexia and Web accessibility: a research review. Universal Access in the Information Society, 9, Rao, R.S., Seliktar, S. & Rahman, T Evaluation of an isometric and a position joystick in a target acquisition task for individuals with cerebral palsy. IEEE Transactions on Rehabilitation Engineering, 8,

337 Wentz, B. & Lanzar, J Usability evaluation of applications by blind users. Journal of Usability Studies, 6,

338 SIGNAGE FOR ALL : ANALYSIS TOOLKIT FOR THE COMMUNICATION SYSTEM OF PUBLIC SPACES Di Bucchianico G. 1, Camplone S. 1, Picciani S. 1, Vallese V IDEA Department, University of Chieti-Pescara, Italy In public spaces and environments, "not find the way" has some obvious practical costs (loss of time, failure to achieve a target) and some more intangible, but no less important, emotional costs. A signage system must take into account both the specificities of places and the extreme variability of its users. In fact, it is necessary to confront on the one hand with the place and the issues relating to its communicative features and on the other with multi-users who may have different difficulties in "finding the way. The paper presents the results of a study on this specific theme. Keywords: Wayfinding, Design for All, Signage Systems. 1 Introduction Places and routes, and so targets and directions, strongly characterize the spaces of our lives, from the urban scale to the architectural one, from domestic to public and socializing spaces. A well-designed environment must allow those who live in it to "orient" themselves: they need both to understand where they are (to build a mental map of the place) and which path to take to get to a specific point without physical or psychological impediments (a draw Action Plan). Three factors generally make the orienteering activity inside public environments and buildings particularly complex: 1. They are usually places which, from time to time, can be subject to modifications through additions and changes respect to the original project; 2. the users of a public space belong to categories with different instances and which in turn contain diversities related to individual skills and abilities of persons. In particular, moreover, users of public spaces and environments move within them often in conditions of high emotional stress (such as in hospitals), in a hurry (as in stations and airports), with lapses of concentration (because while talking to someone or doing something else) and consequently with a low attention level to the elements of the context (that s why, according to a Design for All approach, they are also considered as "limit users"); 3. The overall organization and typological models of public spaces and environments always changes from place to place, with the names of units or functions often difficult to understand and to retain. The widespread sense of spatial disorientation that exists in many public places (buildings and open spaces), therefore, generally depends on a bad design, that is a design approach that doesn t take into account both the "communication skills" of the different parts of the spacial organization, both the variability of people and their ways of interacting with environments, orienteering themselves. The paper reports the results of a research on a "Public Signage Systems for All". The research, that carried out a system of analysis tools, was developed at the Faculty of Architecture, University "G. D'Annunzio "of Chieti-Pescara (Italy), as part of a Master Degree Laboratory in Design for All. In particular, the Analysis System consists of an "Enabling Wayfinding Strategies Matrix (also EWS Matrix) and of an "Enabling 342

339 Wayshowing Guidelines Matrix, (also EWG Matrix). 2 Objectives This research developed a system of design tools useful to the designer to analyse, in the most objective and complete way, both the communicability of the place, the orienteering difficulties/abilities of multi-users, and the different multi-users strategies to receive and interpret information and to orient themselves. These tools facilitate the definition of a requirements list, that is sufficiently complete, comprehensive and useful. The development of these tools can be referred to the more general theme of Design for All Approach. This theme has a specific theoretical base in two different fields of research: the research topic related to spatial orientation and that attributable to the most recent developments of Design for All. In particular, the theme of spatial orientation has been studied and analyzed for the first time in the sixties by Kevin Lynch, who introduced the concept of "wayfinding" (Lynch 1960) to indicate the ability of people to "find the way" to reach a desired place by interacting with their environment through its "signs", that is through their "representability", «namely the quality that provides that a physical object is highly likely to evoke a vigorous image in any observer»(lynch 1960). Weissman proposes four classes of spatial variables related specifically to the built spaces (Weissmann 1981), and later it was introduced the concept of "communicative environment" (Arthur and Passini 1992). It indicates that the built environment and its parts should work as "communication devices". Finally, it was developed the concept of "wayshowing (Mollerup 2005), that refers to the ability of any place to prepare and assist the user to orient himself: in particular, Mollerup has identified nine strategies that individuals use for orientation, which depend by the provision of person, from his previous knowledge and by the information that he can find in the place where he is moving. The Design for All, on the other hand, is based on the principle that, in the increasing complexity of contemporary society, the diversity among individuals is a social "resource " and therefore an opportunity for the project. The objective of social inclusion, that is the active, comfortable and enjoyable participation by all to all daily activities (occupational, social and leisure), may be pursued through the respect and appreciation of differences. Based on these assumptions, the metaprojectual objectives of the research were: To Identify the main issues of the environmental communication and signage of a public space (the application case has been referred to a specific public building, the interiors of the hospital clinic of Chieti, Italy). To define a list of design requirements, specific and inclusive, useful to develope a communicative artefacts system allowing to enable All potential users to find their way through their different capacities, without the fear of getting lost. 3 Method The development of analysis tools took place in stages. The first one refers to the analysis of the actual state of the environmental communication of places, carried out by means of special analysis forms referred to signals and paths. Later, two matrices were developed, in order to to know the multi-users difficulties respect to their different orienteering ways (the EWS Matrix ) and to allow the designer to to detect the best design strategies for the development of a enabling communication system of artifacts (the EWG Matrix ). Overall, it is a tools kit that allow both to highlight common problems and resources of environment, and to aware the potential difficulties of the "multi-users" with respect to the various implemented "orienteering strategies". 343

340 In particular: The EWS Matrix ("Enabling Wayfinding Strategies Matrix ") derives from the need to understand how the nine wayfinding strategies (Mollerup 2005) can become for all. Namely, how can they enable all potential users with specific difficulties, allowing them to be able to orient themselves using their own "spare capacities". In particular, the matrix relates in several ways 46 major disabilities related to orienteering and identified through the literature; 17 main capabilities/problems related to orienteering activity; 9 Wayfinding strategies; 8 macro-requirements referred to the environmental communication and signage. It is a tool of both "knowledge", that is useful to analyze the specific features of the context, and "project", as it also provides useful and objective information to identify the most effective wayfinding strategies in reference to the same context (Figure 1). Figure 1: the EWS Matrix ("Enabling Wayfinding Strategies Matrix ") The EWG Matrix ("Enabling Wayshowing Guidelines Matrix "), or matrix of the "Guidelines for All" is designed to provide the designer with a system of guidelines changing to the changes of the framework conditions (namely, in reference to the place and the multi-users). It can be used starting from the results obtained with the previous matrix, and it eases the selection of strategies for the design of the communication system of artifacts. The designer, therefore, can understand the best wayshowing inclusive strategies for any specific users and environmental characteristics. The basic idea of the research is that through the EWS and EWG Matrices it is possible to define specific design requirements related primarily to the needs of limit users and then they will be extended to the generality of people. This in full harmony with the so-called Design for All Approach, based on the enhancement of the concepts of diversity, inclusion and equality. 4 Results The methodological apparatus developed by the research were then applied to a concept design that is presented in the end of this paper. It consists of a design concept of an enabling communication system of artifacts for the interiors of a key Unit of the hospital clinic of Chieti (Italy). 4.1 Analysis The hospital clinic of Chieti (Italy) works since In particular, the hospital extends on a hilly land, and is divided into several buildings that are organized into four groups on 344

341 different levels and that are connected by "nodes" and linear paths. The research focused on the problems arising from the moves of the multi-user: generally the movements start from the main entrance, located on the 7th level, towards the main destinations within the hospital. The analysis of the environmental communication, that was developed using specific observation forms and questionnaires, has highlighted the main problems related to the environmental communication and to the orienteering skills of its usual kind of users, with particular reference to the occasional ones. The use of the EWS Matrix and of the EWG Matrix provided an indication on which are the most appropriate wayfinding strategies in reference to the specific studied context. This allowed the definition of a requirement table, that was extremely extensive and objective. 4.2 Concept Design The issues of environmental communication and signage showed the crucial role of "nodes" in the hospital clinic of Chieti, in order to ensure a safe and proper orientation of users. In particular, six are the "nodes" that allow access to the various functional areas of the building. Through some typological schemes, it was possible to define the concept of the project, which refers to the idea of an entry and exit portal (figure 2). Figure 2: Simulation of the orthopedic unit entrance So, three different kinds of information portals were developed: through different sensory channels, they inform users about the place where they are and which direction to take to reach their desired locations. The design concept went so far, as to choose also the most suitable materials for the production of the information supports. In particular, the choice of materials was carried out according to the application flexibility of the signage, to the requirements of cleanability, of resistance to impact, and especially to the availability of color variations of the information supports, this considering that the project makes extensive reference to the use of colors. 345

342 5 Credits The research described here was conducted under the coordination of Prof. Giuseppe Di Bucchianico within the "Interior and exterior design of sustainable living" Degree Laboratory, academic year 2009/2010, in the College of Architecture, University "G. d'annunzio "of Chieti-Pescara. In particular, the research was conducted with candidates Stefano Picciani and Valeria Vallese. The design results reported in the Paper, on the other hand, refer to the degree Thesis of Stefano Picciani, titled "The hospital signage for All. Enabling communicative system of artifacts for the interiors of the Hospital Clinic of Chieti" (supervisor Prof. G. Di Bucchianico, Co-supervisor Prof. S. Camplone). The figures inserted in this paper are taken from the above mentioned dissertation thesis. The present paper was written from Giuseppe Di Bucchianico (Paragraphs 1, 2, 3) and from Stefania Camplone (Paragraph 4). 6 References Arthur, P. & Passini, R Wayfinding-People, Signs, and Architecture. New York: McGraw-Hill. Lynch, K The Image of the City (Tr. It.: L immagine della città. Padova: Marsilio, 2006). Mollerup, P Wayshowing. A guide to Environmental Signage Principles & Practices. Baden: Lars Muller Publishers. Weissman, J Evaluating architectural legibility: wayfinding in the built environment. Environment and Behaviour, 13,

343 4th parallel sessions Tuesday September 20, :40-15:00 347

344 A4: HUMAN FACTORS IN PRODUCT & SERVICE DEVELOPMENT AND ORGANISATIONAL ERGONOMICS A4.1 From ideas to innovations: how a network of experts develop ideas Esa Kannisto A4.2 ework challenges and working methods Tommi Autio A4.3 Networking and knotworking challenge work practices - case rail traffic control Arja Ala-Laurinaho A4.4 Age-friendly shift systems - do they exist? Mikko Härmä 348

345 FROM IDEAS TO INNOVATIONS: HOW A NETWORK OF EXPERTS DEVELOPS IDEAS Kannisto, E.M.K University of Jyväskylä, Agora Human Technology Center, PL 35, FI University of Jyväskylä, Finland, 1. Introduction An inventor will often travel a long way from idea to innovation. In Finland, inventors can receive support and assistance from local organizations for development activities in various stages of the process. One such organization is the regional Innovation Advisors group of the Foundation for Finnish Inventions (in Finnish: Keksintösäätiö ), which supports the early-stage development of ideas. Innovation Advisors run Product Track Teams (PTT) (in Finnish: Tuoteväylä ) that comprise experts from a variety of fields and help develop and evaluate ideas. Currently in Finland, the 14 Product Track Teams involve a total of 158 experts (y. 2010). These experts have a network within the Foundation for Finnish Inventions called the 30 sec forum. This intranet network provides a protected forum where experts can discuss the ideas presented in the teams. The idea of the forum is that any experts can ask anything regarding the ideas, and other experts can briefly and quickly give tips, related ideas, criticism of the idea etc. This research paper investigates the types of conversations on this forum. Keywords: innovation, ideas, development, support organisation 2. Research Object and Method The object of the study was one year s (2008) discussions on the forum. The purpose was to find out how the process worked and, more specifically, what was asked and how these inquiries were answered. During the investigation period (2008), 41 distinct conversation topics were opened. Answers to these questions totaled 116. The majority of the inquiries involved general themes, the idea of innovative characteristics, and who would be the expert in the area in question. Meanwhile, the majority of responses offered expert contacts and practical tips for the development of similar ideas. We also determined who were the most active debaters, who were the respondents, and the relationship of these two groups to the most active inquirers. The methods used to study this expert forum were narrative analysis and discourse. 2.1 About Innovations Because the present work studies the development of ideas into innovations within a certain support system, and observations of how ideas were dealt with inside that system, at first it is necessary to clarify what is meant by the concept of innovation in this study. Schumpeter (1939) viewed that innovations are new products (services or goods), or new production methods, new ways to commercialize products, new markets for products, new raw materials or semi-finished products for manufacturing other products, or new industrial structures on the market. This definition is widely used and quoted in literature on innovation, and it highlights the viewpoints of utilization and industry. Rogers (2003) believed that an innovation is a new product, industrial or technological invention, but also an idea, practice, or object that individuals consider new. This is such a broad definition, 349

346 that it is difficult to find anything that actually isn t an innovation. There are a number of classifications of innovations, such as architectural innovation, market niche innovation, innovation regular, innovation revolution, as put forward in Abernathy and Clark s model (1985), and, for example, the similar classifications in the models by Chandy and Tellis (1998) and Tushman et al. (1997), all of which stress the impact of new technology on the market, customers. The concept of innovation has a broad starting point in this study: a novelty or change that is utilized or planned to be utilized by some party on the market or in production. Especially of interest is the change in thinking and its practical effects. Observations of ideas have already been made in the area of ergonomics. A broad definition of ergonomics is given by the IEA (International Ergonomics Association): Ergonomics (or human factors) is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance. The focus of this study is in the field of innovation research, on the perspective of the different phases of the innovation development process. 2.2 About the Development of Technology in General Much has been written about technology, and in particular, about its development. Describing the development of technology in evolutionary terms, so that new technology is always based on earlier technology all the way back to learning to make use of natural phenomena, explains the combinatory and self-developing nature of technology. Combinatory refers to combinations of earlier technologies that are used in newer technology. The self-developing nature of technology means that new technologies lay the foundation for future technology. (W. Brian Arthur 2009) The combinatory aspect of technology shows clearly the huge amount of new combinations that are generated as the amount of technology increases: in which n = the total amount of earlier technology that is available and suitable to be utilized by new technology k = the amount of earlier technology needed to create new technology The following table is a combinatory calculation that shows how one new technology requires three existing technologies. We can see that as earlier technologies increase (as shown on the horizontal axis), the number of possible new technology combinations grows exponentially. 350

347 Table 1 Table 2 Table 1: New technology combinations when the number of earlier technologies needed to create one new technology is 3. Table 2: New technology combinations when the number of earlier technologies needed to create one new technology is 10. As earlier technology increases at a speed of one new technology (e.g. a new invention), the amount of possible new combinations of earlier technologies grows rapidly into the thousands. The technologies in question above are simple, which only need a few previous technologies. In today s world, where even the smallest technological invention, such as a computer mouse, requires a combination of hundreds of previous technologies, the possible number of combinations rises rapidly to astronomical and uncontrollable levels. This indicates that developing and planning new inventions requires more than just systematically going through the potential combinations to develop present technology into new technology. Saariluoma s theory of Micro Innovation and its process model was developed to describe the mechanism of creating new innovations (Saariluoma & Kannisto, 2008; Saariluoma et. al 2008, Saariluoma et. al ) In developing new technologies, systematically going through all the possible components of previous generations is not reasonable, and it is often ineffective. Vision, experience, an innovative approach, and expertise are all needed to develop new technology. This also applies to the assessment of new technology. More extensive expertise, knowhow, and broad outlooks are needed to assess new technology. (Saariluoma 2002; Saariluoma & Leikas 2010) The Foundation for Finnish Inventions Product Track Teams model was developed to meet this challenge of assessing new technology. In particular, assessing the perspectives of special fields such as ergonomics requires expertise. 2.3 About Ideas, Innovation, Assessment, and Development of Expert Forums In Finland, there are many public systems for developing ideas and inventions, such as Tekes the Finnish Funding Agency for Technology and Innovation, local development companies, services, and the Foundation for Finnish Inventions. (Keksintösäätiö 2011) The Foundation for Finnish Inventions works through regional Product Track Teams. It is a toll-free expert advice service for individuals. The main task of Product Track Teams is to evaluate ideas and inventions, and to create opportunities for profitable business. (Keksintösäätiö 2011) Product Track Teams make applications for the initial assessment of new ideas and inventions for commercialization and provide recommendations for further development. Teams operate in several regions in Finland. They are run by ELY centers (Centre for Economic Development, 351

348 Transport and the Environment) and are made up of the Invention Foundation s innovation experts. (Keksintösäätiö 2011) These team members are consultants and experts in developing and making use of ideas and inventions in various fields. Such a multi-field approach is necessary to obtain a viewpoint on the first assessment of ideas that is as objective as possible. (Keksintösäätiö 2011) Those ideas and inventions, which the team believes to have potential markets, especially in growth companies and internationally successful companies, are sent by the Product Track Team to the second phase at the Invention Foundation. The selected ideas are reviewed by sectorspecific experts and Business Development Managers (BDM). In this reading, BDM s look for potential customers of the ideas and inventions and bring them together with the inventor to develop them further. Local business ideas are suitable for controlled development assistance and funding bodies such as regional development companies. (Keksintösäätiö 2011) Year 2008 Applications for funding, all together 961 pcs, e Finance, funded inventions 253 pcs, e Exploitation of inventions and innovations - Contract-based: 11 pcs - The applicant s own business: 26 pcs - Ongoing funding and other donors: 58 pcs - Further measures, total.: 95 pc Table 1: The Foundation for Finnish Inventions, 2008 (Keksintösäätiö 2011) Product Track Teams run networks that include universities, polytechnics, Tekes, Avera, ELY centers, start-up centers, business incubators, companies, and private consultants. Teams are always looking for new ideas in their own regions and bring the most interesting ideas to be assessed. (Keksintösäätiö 2011) Figure 1: The Foundation for Finnish Inventions: Our Services Keksintösäätiö 2011) 352

349 Figure 2: the Product Track Team activities processes (Keksintösäätiö 2011) It seems that the Foundation s operations (Figure 1 and 2) amounted to just under 30% of the overall demand for its services in 2008 (see applications in Table 1). 3. Results Expert Forum Discussions 2008 (30 s forum) DISCUSSIONS OPENED STARTING POINT CLARIFYING AND DEVELOPING A NEW IDEA 1 2 REPLIES CONTACTS / INFORMATION OFFERED 7 50% % SPECIALISTS 3 9% DEVELOPING AN OLD INNOVATION 4 33% WEB SITES 9 26% OTHERS 4 33% COMPANIES IN THE FIELD 4 12% WHAT SCHOOLS, etc. 1 3% SEEKING 4 33% HELP OFFERED % ASKING % INFORMATION 7 21% SEEKING SOURCE OF INFORMATION 6 18% SPECIALISTS 1 8% STATED/SUSPECTED ABOUT THE TECHNOLOGY % MATERIAL SUPPLIERS 1 8% EXISTING PRODUCT, PATENT, etc % COMPANIES 2 17% EXPRESSING A TECHNICAL OR OTHER PROBLEM 4 12% 1 QUESTION ABOUT TECHNOLOGY 8 TECHNICAL OR OTHER SOLUTION 9 26% EXISTING/COMPARABLE 8 67% OTHERS, WHAT 9 26% NOVELTY OF THE IDEA 7 58% COUNTER- OR FURTHER QUESTION 5 15% TECHNICAL PROBLEM 1 8% FURTHER/DEVELOPMENT IDEA 3 9% TECHNICAL SOLUTION 2 17% REJECTION PROPOSAL 1 3% Table 3 43 new conversation strings were posted on the foundation s discussion forum in 2008, of which 41 were enquiries about products or business. A total of 116 answers were given. 12 questions related to ergonomics were asked. These received a total of 34 answers. The technological topics of these questions were: animal-related technology, safety technology, snow technology, weapons technology, infrared technology, construction technology, automobile technology, technology for the physically impaired, and technology to ease the everyday life of people with disabilities. 353

350 Only one idea was proposed for rejection; otherwise the ideas were deemed worthy of development and research. 17 responses contained warnings that the proposed technology could already be invented, or that it needed more research. In fact, only one idea did not receive any suspicions of an already existing technology or invention. All questions sought or asked for specific information, which was also given. Experts in the field or companies were sought in a couple of cases, but in almost all of the answers, experts (17 responses), data sources, companies, or educational institutions were suggested. It appears that in assessments concerning new technology that are difficult or require special expertise, people adhere strictly to the know-how of experts in the field. Problems are identified, and their solutions can be analyzed, but the tendency is to give the final assessment of the idea or invention to an expert or expert group. 4. References Keksintösäätiö (Foundation for Finnish Inventions, 2011), Rogers, E.M Diffusion of Innovations. 4. edition. Free Press, New York Schumpeter, J Business cycles: A theoretical, historical and statistical analysis of capitalist process. New York: McGraw-Hill. Abernathy, W. J. & Clark, K. B Innovation: Mapping the winds of creative destruction, Research Policy, Volume 14, Issue 1, February 1985, Pages 3-22 Chandy, R.K. & Tellis, G.J Organizing for radical product innovation. Working paper, No , Journal of marketing research, 1998 JSTOR, Cambridge, Mass. : Marketing Science Institute, MSI, Gatignon, H., Tushman, M. L., Wendy Smith, W. & Anderson, P A Structural Approach to Assessing Innovation: Construct Development of Innovation Locus, Type, and Characteristics. Management Science, Vol. 48, No. 9, September 2002 pp International Ergonomics Association IEA, What is Ergonomics, Arthur, B.W The Nature of Technology: What It Is and How It Evolves, Free Press (2009) Saariluoma, P., & Kannisto, E Designing micro-innovation mechanism: How basic science can be implemented in product development. Enterpreneurship as an Engine for Regional Development, RENT XXII 173. European Institute for Advanced Studies in Management (EIASM). Saariluoma, P., Kannisto, E. & Kujala, T Micro-Innovation Mechanisms: The Problem of Innovation Cycle, The 10th IBIMA Conference on Innovation and Knowledge Management in Business Globalization and for inclusion in the conference proceedings. pp IBIMA Saariluoma, P, Kannisto, E. & Kujala, T Analysing Micro-Innovation Processes: Universities and Enterprises Collaboration. the 11th IBIMA Conference on Innovation and Knowledge Management in Twin Track Economies and for inclusion in the conference proceedings. IBIMA. Saariluoma, P. & Leikas, J Life-based design - an approach to design for life. Global Journal of Management and Business Research GJMBR, 10 (5), Saariluoma, P Ajattelu työelämässä. Helsinki, Finland: WSOY. 354

351 ework challenges and working methods Autio, T 1 & Alila, H 1 1 Work Science Unit, Department of Industrial Engineering and Management, University of Oulu, P.O. Box 4610, FI University of Oulu, Finland The working environment is nowadays in constant change and there are several factors affecting the change like the central role of ICT in everyday work. Technology and know-how have become important factors for competitiveness. Wider use of ICT as a tool and the role of personnel are highlighted as an essential element in successful change towards using new working methods. This paper introduces one of the case organisation s of the eprocesses project and their development activities during the project. The idea is to describe how the development was done and what the used methods were. Also this paper discus ework challenges. Keywords: ework, telework, participatory method, implementation, utilisation 1. Introduction There are several factors affecting the change of the working environment like the growth in demand for safety and sustainable services and products, global division of labor, and the central role of ICT in everyday work. Technology and know-how have become important factors for competitiveness. Wider use of ICT as a tool and the role of personnel are highlighted as an essential element in successful change towards using new working methods (Vartiainen et al. (2007), Vilppola & Terho (2008) and Väyrynen et al. (2006)). The eprocesses project (Etätyön prosessit eprosessit, ) emphasised simultaneous and balanced development of wellbeing, work processes and tasks through ework and it proceeded the requirements for eworking pilot project (Etätyön edellytykset, ). The definition of telework or ework varies depending on the case and situation it is used. Traditional work takes place at the work place, in the premises of the employer when telework is carried out in the distance and away from the actual working place. Flexiwork and mobile work definitions can be used when work takes place in changeable and in advance undefinable places. Term ework is used when work is done utilising information networks and/or it takes place in distributed locations. In telepresence interaction and collaboration is more intensive in comparison with previous definitions (Hanhike 2004, 14). The official definition of telework according to the European Framework Agreement of Telework (2002) is Telework is a form of organising and/or performing work, using information technology, in the context of an employment contract/ relationship, where work, which could also be performed at the employer s premises, is carried out away from those premises on a regular basis. Considering ework it is vital to recognise that technology has to adapt to meet the requirements of work, not vice versa. On the other hand, a different form of ework technology provides great solutions to mobile and network related work. How extensively ework affects to and what it requires from the business processes and the management of organisations is not yet clear (Vartiainen et al. 2007). 355

352 This article consists of the objectives from the project as well as used methods and results. Participating organisations are also described at a general level from which one of the organisations is selected at case organisation in this article. 2. Objectives of the eprocesses project eprocesses ( ) was funded by the Finnish Funding Agency for Technology and Innovation (Tekes) and the European Regional Development Fund (ERDF) and it was administrated by Work Science Unit, University of Oulu. The Work science unit of the department of industrial engineering and management of the University of Oulu does a multidiciplinary research in the fields of conditions at work, working tools and work itself. One of the core areas of the research is the study of the interfaces between human and technology. Considering ework, the work science unit has been developing both videophone technology and its implementation, utilisation and use as a tool in social and health care organisations in many projects (ie. Haimuumaa and KouHa). The main goals of the project were to study collaboration and eworking of the management and business processes of the case organisations. The case organisations operated in the private and public sectors. All the organisations had either implemented ework technologies at some level already or they had a strong need to utilise ICT as part of their work processes. The challenges of the implementation of ework into work environment are: 1) Implementing and utilising ICT as a beneficial working tool. 2) The change of the work processes. 3) The personnel s participation and commitment to the process of change. On of the key factors of the project were to include and involve the personnel of the case organisations in the advance of the project starting the day one. To ensure this involvement the personnel were given the possibilities to affect the content of the project so they would have a feeling of influencing. The selected, examined and soon to developed work processes were chosen by personnel of the case organisation. The selected work package method supported this approach. 3. Methods The structure of the project leaned heavily on the participation of the case organisations and utilisation of work package method. Six case organisations took part in the project. This article presents the process of the one case organisation. Selected case organisation provides and takes care of the information and communication technology, hardware and software, in the public sector. The case organisation selected development group including the personnel and management. Meetings took place every three to four weeks and at least six members of development group participated in the meetings. The needed information for developing was collected using participatory methods like focus group interviews and group brainstorming technique. Project researchers generated the framework to help development processes of the case organisations. This framework was called the working method (fig 1). The whole working method was formed with three work packages, but this article introduces only first two of them which were essential to the development work in the case organisations. 356

353 WORK PACKAGE #1 - mapping the present situation - objectives considering the needs and goals of eprocesses WORK PROCESSES OF THE CASE ORGANISATION -leadership - personal tasks - customer processes - subcontracting etechnology eprocesses OF THE CASE ORGANISATION -leadership - personal tasks - customer processes - subcontracting WORK PACKAGE #2 - building/forming the emodel for the needs and goals of case organisation comparison/ selection Customised emodel Fig. 1. eprocesses project s working method The Work package 1 focused on selecting the desired business processes and mapping the present situations of the case organisations. Activities in the work package were planned together with the development group of the case organisation. Activities aided the organisation to recognize, develop and implement eworking methods and tasks by mapping the existing ework procedures and processes of the organisation and discover how the management and leadership possibly influence those processes. The case organisation in question considered thoroughly what kind of development they would like to participate and what would be the end result. They chose to develop their IT system and ordering procedure. The development group mapped the current situation using flowcharts by themselves. Based on this flowchart the researchers and development group used group brainstorming technique where the flowcharts were reconstructed to improve visualisation and understanding. It appeared quickly during the flowchart drawing that the recent ordering process of computers, software and peripheral devices, needed development. There was major lack of methodicalness, for example the ordering procedure included several badly controlled or even uncontrollable ways to make the order. The work package 2 measured and compared the results that have gathered via the first work package and the next phase was to create the testing models. The comparison was based on the current situation/current processes and the eligible processes of the case organisation. The customised emodel or eprocess for the needs of the case organisation was ready after the several iterations. The group brainstorming technique and process prototypes helped to build the new customised model where the order system is described as perfectly as it could be. Next the development group constructed the model to demonstrate how it would act in reality. On our case organisation, the work package 2 manifested as the next phase(s) of developing the process focused on first creating and then evolving the new desirable method of the ordering procedure. This evolving process included the presence of ework elements into the ordering procedure to meet the prerequisites made earlier in the process. Numerous iteration circles were necessary to refine the new ordering procedure. 357

354 4. Results During the development process it was found out that there were many customs in the ordering and assembling processes that hindered the work and slowed the lead time of a finished product. The prevailing situation was that the process of assembling the new computer started after the order was received from the customer. When the development group of the organisation was describing the process, they realized that the most of the orders were very similar to each other. There were some minor exceptions but the user interface and the basic software were basically the same. It was found out that there is a possibility to assemble so called semifinished computers beforehand, and when the actual order is received just install the needed software and special requirements to it. This new way of working would save time and other resources and the lead time of assembling would shorten significantly. The other significant notice was that the whole ordering system would change totally from the current, very diverse practice. There was no standard how to order the computer. The new working method and process would provide an ordering by a special form. This form would be built on a database and the database would involve all the possible variations concerning the customer needs and requirements. The database would collect all the data and the assembling group would get the information concerning the assembling, software, special requirements and invoicing information. Altogether the whole ordering procedure would be altered to utilise ework and provide better and more reliable service to the customer. This reality based model, helped to assess how the ordering process should work and what are factors affecting the process. The main findings were: 1) there is a need for a semifinished product (computer) which can be assembled into a buffer stock beforehand 2) after receiving the order the assembly team can use the buffer stock of semifinished products to speed up the lead time 3) the ordering process is carried out by the customer from the beginning to the end via intranet - including the invoicing process. The working method proved to be an efficient way to perceive and affect all the important factors considering the needs and goals of all the various case organisations and to have control over the changes in the organisations as well. The project was originally applied as a three-year project. The project decision was for half of it. This meant that there was not enough time to carry out all the tasks which were planned in the planning phase. The case organisation has to do the end part of the developing phase by them self. In this case, the actual implementation and evaluation will be carried out with the resources of the case organisation. The challenges of the implementation of ework into work environment were presented in this paper on Chapter 2, objectives of the eprosesses project. Those challenges were: 1) Implementing and utilising ICT as a beneficial working tool 2) The change of the work processes 3) The personnel s participation and commitment to the process of change. 358

355 In this project, the selected work package method answered and overcame all these noted challenges. Used method relied heavily on the participation of the project organisations and the participation of the development groups was intense through the timeline of the project. The participating organisations chose and selected the issue they wanted to develop, therefore the idea came from the organisation and development group themselves and it was and felt like their own idea. The commitment to develop your own ideas is more beneficial in comparison with the developing ideas that are given to you from outside or from management level of the organisation. The working method of the project supported thorough mapping of the prevailing situation of the developed matter and the development of the new selected method were done in numerous iteration circles. The threshold considering the change of the work processes was much flatter than anticipated because this iterative approach helped personnel to handle and discuss the new working method they were going to eventually use beforehand. 5. Discussion In Finland there have been several projects, campaigns and ideas to support workplaces and people to use more ework tools and possibilities in their work. Those attempts have not been successful nevertheless ework could bring flexibilities to work. Also the image that the working is executed between home and workplace is only a part of the possibilities of IT systems and virtual tools. In the field of knowledge work for example, ework should be allowed when it has most benefits considering the productivity, cost efficiency and, last but not least, when it supports sustainable development. Sustainable development includes financial, environmental and social criteria. ework can be one of the ways to pursue productivity, successful and wellbeing at work in the work processes (Väyrynen 2010). The researchers of the eprocesses project interviewed 14 persons and 13 organisations concerning ework, wellbeing at work, processes and leadership. The most of the interviewed persons worked as managers. The organizations were Finnish (11) or Spanish (3). The main findings were that there should be better infrastructure to use virtual tools (broadband connections and quality of the connections) and the virtual tools should be easy to use and there should be a good training for the tools. The most important thing between a manager and a worker is trust. The interviewees thought that the trust does not build without the acquaintance of the persons and clear rules. Some of the interviewees pointed out that there have to be tools for control the worker who is working outside the company premises. On the contrary, some of the interviewed persons mentioned that if people trust themselves enough, then it is possible to work together very flexibly. The attitude concerning ework was mainly positive but the using of ework tools needs strong interest from the organisation and the commitment of an employer and an employee. The idea of concentrating in processes how things should be made could help to utilise the possibilities of ework more. One idea of this article was to describe a case where ework is understood broadly than normally and to present ework as a tool for having an effect on the case organisation and its customers. Because the utilisation of the created eprocess means that the new working way means implementation among most of the customers; the case organisation takes care almost individuals in the IT issues. This new eprocess would be relevant proximately half of them. Eventhough the actual implementation of eprocess is still in progress, the project helped the organisation to realise what kind of improvements they should do to develop their activities more efficient and customer-based. 359

356 References ETUC European Resource Centre European Framework Agreement of Telework. k%20en.pdf. Hanhike,T. (edit.) E-työ Suomessa ETR:n selvitys ja toimenpidesuositukset e-työn kehittämismahdollisuuksista. E-työn yhteistoimintaryhmän julkaisu. Työministeriö. Helsinki. Vartiainen, M. & Kokko, N. & Hakonen, M Hallitse hajautettu organisaatio Paikan, ajan, moninaisuuden ja viestinnän johtaminen. Talentum. Helsinki Vartiainen, M. & Hakonen, M. & Koivisto, S. & Mannonen, P. & Nieminen, M. & Ruohomäki, V. & Vartola, A Distributed and Mobile Work: Places, People and Technology. HUT, Helsinki. Vilpola, I.,& Terho, K.2008.Tehokkuutta tuotannon tietojärjestelmiin - loppukäyttäjät mukaan määrittelyyn. Teknologiateollisuus, Helsinki. Väyrynen, S. (2010). Etätyön prosessit eprosessit -hankkeen loppuraportti. Väyrynen, S., Röning, J. and Alakärppä, I User-Centered Development of Video Telephony for Servicing Mainly Older Users: Review and Evaluation of an Approach Applied for 10 Years. Human Technology, Volume 2 (1),

357 NETWORKING AND KNOTWORKING AS CHALLENGES FOR RAIL TRAFFIC CONTROL Ala-Laurinaho A. 1, Seppänen L. 1, Heikkilä H. 1, Piispanen P Finnish Institute of Occupational Health, Topeliuksenkatu 41 aa, FI Helsinki, Finland Work today is increasingly carried out in different kinds of networks. This study presents a case of the reorganization of traffic control tasks. We investigated how the planned way of working in the network was realized in practice. We argue that in the network of organizations contributing to traffic control, two different modes of collaborative work are needed: networking and knotworking. Keywords: Rail traffic control, network 1 Introduction Work is increasingly carried out in different kinds of networks, as organizations seek novel, competitive ways of producing their products and services. This study presents a case in which a traditional state-owned Finnish railway company was split into a network of several private and public firms, due to EU regulations and requirements for free competition, cost efficiency, and technological developments enabling novel work structures. We focus on rail traffic control, and investigate, what kind of new organizational network was formed, and how the planned way of working in the network was realized in practice. 2 Theoretical approach and research project As its approach, this study uses the activity theory and its work-related branch, developmental work research (Engeström 2000). The core of the approach is that human activity is always objectoriented. The activity system model is used as an analytical tool to understand and describe collective activities. The entire organization, or even the network of organizations as in the case of traffic control, is analysed as a network of activity systems, connected to each other by the ultimate object of the entire network. The study of changing rail traffic control was conducted in two research and development projects in Southern Finland during and The aims of the projects were to support the organizational and technical change processes. The data includes interviews with the traffic controllers and representatives of different organizations related to traffic control; observations of daily work situations; five workshops on disturbance handling in traffic control; documents on traffic control work and disturbances; participation in a series of meetings and management's briefings to the personnel; and a benchmark visit to a traffic control centre in Oslo. We video recorded the observations, and audio recorded the interviews and the discussions in the workshop. Section 3 on the network of rail traffic control is based on all of this data. The specific data analysed for this paper, namely the observations of the everyday work situations of traffic controllers and their collaborative partners, is more closely described in Section 4. The interpretation of the video, however, was supported by all the data collected in the projects. 3 Network in rail traffic control The organizational changes are connected to the history of railways in Finland: until the 1990's the state-owned Finnish State Railways (VR) was responsible for practically all aspects of rail traffic. Throughout history, traffic control as a function, and the tasks of traffic controllers have been intertwined with other functions and tasks of railway traffic. For example, traffic controllers have developed a strong role in scheduling maintenance work, planning rolling stock rotation, 361

358 rescheduling train traffic, and being general informants of the ongoing traffic situation to stakeholders. Though the Finnish Rail Administration (FRA) was established as early as in 1995 to take care of the infrastructure, traffic control, and traffic information, the functions in the railways remained tightly intertwined. Thus, still in 2007 the traffic controllers' duties included not only monitoring and controlling traffic but also providing passenger information, organizing engine and carriage rotation, and guiding maintenance groups, etc. The organizational changes in 2007 aimed at further clarifying the division of tasks and responsibilities in the functioning of the railways. New organizational units were established: the Information Centre (by FRA) for passenger information, and the Rail Transport Centre (by VR Ltd) for staff and rolling stock rotation, transport planning, and train operators' tasks etc. Due to these organizational changes, the former tasks of the traffic controllers are now executed by a network of different organizational units, even by different organizations. Traffic controllers, on the other hand, focus on monitoring and controlling the local and regional traffic situation (Figure 1). To support the new way of working, a variety of agreements on the division of labour, rules of conduct, coordination etc. were made between the organizations, and new work practices and tools were developed in each unit/organization. Nevertheless, from the beginning of the development of the network, the need for intensive cooperation has also been recognized. Disturbance situations in particular require intensive collaboration and the crossing of organizational borders, as well as continuous co-creation of the understanding of the evolving traffic situation. The FRA and VR have developed technical systems and information-sharing devices to improve processes and situational knowledge. During our projects, several proposals to facilitate information-sharing were made by rail traffic controllers and other actors in the network. However, as Fields, Amaldi and Tassi (2005) point out in their research on airport traffic control, when using the concept of common information space (Fields et al., referring Schmidt and Bannon 1992), in addition to the information being shared or commonly available, interpretations of it must also be sufficiently uniform. Farrington-Darby and Wilson (2009) in turn argue that in complex work systems, such as rail traffic control, detailed understanding of both the immediate and remote social environments strongly contributes to successful skilled performance. In our project, proposals such as visits to each other's worksites, job rotation across organizations, action cards (defined key procedures in specific large disturbances), and disturbance workshops were means with which to enhance shared interpretation of the available information and the understanding of the social environments of colleagues in the network, as well as to anticipate the ongoing processes of traffic. 362

359 Rail Transport Centre (VR) tools Traffic Control Centre subject: traffic controllers, senior traf. controllers tools, signs object: traffic situation outcome: effective disturbance handling, safe and fluent traffic object: rotation of rolling stock rules Information Centre object: passenger information community tools subject: operators division of labour subject: information workers rules community division of labour rules National Traffic Man. Centre object: national traffic situation community tools division of labour subject: national traffic controllers Figure 1. Rail traffic control network rules community division of labour 4 Objective and data: rail network work in practice The organizational change project started in autumn 2007, and in we did follow-up observations to investigate: how the planned way of working is realized in the network, and, especially, how the partners in the network collaborate (in which issues, by which means). The observations were conducted during the rush hours, which were specifically vulnerable to any deviations in traffic. The data consists of three sets of two-hour recordings, two in October 2010 and one in February We made recordings simultaneously in 1) the Traffic Control Centre (TCC) in Helsinki, 2) the National Traffic Management Centre (NTMC), 3) the Rail Transport Centre of VR Ltd (RTC), and 4) in October, also in the Depot. In the analysis of the data, we first listed the main course of action and collaborative situations in each recording, and second, we transcribed the most interesting excerpts (e.g. several units of the network participated, or problem-solving situations).the transcriptions of different videos were then combined with the help of timing and logic of discussions. Here, we will show two events that demonstrate variability of forms of action that we believe are central from a developmental perspective. 5 Results Generally, the traffic situation during both video recordings in October was fluent and no major disturbances occurred. The connections across organizations mainly included information-sharing and checks, and traffic controllers commented on the situation as peaceful and the work environment as quiet. The traffic situation in February, on the other hand, was very busy. The weather was difficult (under -20 C), several long distance trains throughout the country were late, several engines broke down, and there were driver shortages and difficulties in personnel circulation from one train to another. The senior traffic controllers, the traffic controllers, and the operators of VR's RTC were continuously occupied by phone calls and monitoring and control tasks. 363

360 The following describes two events of collaboration in the network. The descriptions are combined from the video recordings in the NTMC, TCC, and VR's RTC, and the Depot (event 1). Event one was recorded in October A faulty train must be driven to a depot. The course of action and connections needed in solving disturbance are described below. 1) The national traffic controller (NTC) gets a phone call from the regional senior traffic controller (STC) in Kouvola who informs him that the JKV system (system for monitoring and controlling train movements and location) is faulty in train 68. The NTC decides to allow train 68 to enter Kerava (connection station to Helsinki local traffic) at lowered speed, instead of travelling to the Helsinki main station, and passengers have to change to local trains in Kerava. The empty train is to be driven to the depot. The NTC tells the STC to instruct the train driver accordingly. The NTC also says that he will inform the Helsinki TCC of the situation and plan. 2) The NTC phones the operator of the VR's RTC to inform him of train 68 and to ask about the next movements (schedule) of the train. The operator checks the location of the train on the display and the next movements of the carriages on the printed train/carriage rotation list. He informs NTC that train 68 was next going to the depot anyway, and agrees with the plan. The operator also ensures that the NTC will send a JUHA message (SMS message system for different groups) to the relevant stakeholders, and the NTC confirms this. 3) The NTC phones the Helsinki TCC and informs the STC of train 68 and the plan. 4) The NTC sends the JUHA message to stakeholders 5) The info-worker announces the situation of train 68 via loudspeakers on platforms. (Repeated announcements approximately every 10 minutes) 6) The RTC operator receives a phone call from the conductor of train 68; they discuss the passengers' further train connections, using information systems on train schedules, platforms and tracks. 7) The RTC operator sends a detailed JUHA message concerning further connections. 8 ) The operator of VR's RTC phones the depot's shunter to make sure he is informed of the situation of train 68. The decision and the information procedures followed the distribution of duties and agreed protocols of the network. The NTC decided if and how near to Helsinki-city the faulty train was allowed to drive, and other partners organized the next steps and informed further parties. All in all, based on the video recordings, the working of the network seems to follow the distribution of duties and tasks of the network when the traffic situation is normal or the disturbances are only minor and easily solved. A couple of points are noteworthy: first, it was revealed that the NTC did not know enough of the next movements of the trains (i.e. rolling stock) and had to ask for information from the RTC operator. This inquiry regarding the rolling stock also happened several times in other observations during the project, and shows that although the NTC is willing to take the train operator's view into account in the decisions, the current information systems do not provide him with this information. Second, the STC, TCs and info-worker discussed the traffic situation continuously, acting as important informants, co-interpreters and supporters to each other, despite their different organizational units and different roles in the network. Event two was recorded in February. In the event, train 165 to Tampere is delayed in the depot because of a driver shortage, thus delaying its departure from Helsinki. 1) In the VR's RTC, Operators A and B (trainee) discuss whether it is possible to make up the delay of train 165 when turning back from Tampere, but realize that the train is scheduled to go on to Turku, with only 20 min turning time. Nevertheless, there seems to be time to make up the delay in Turku. 2) In the NTCC, the night and morning shift controllers discuss the delay problem of the Tampere trains; all the trains are late, but as there are several connections each hour, one train could be cancelled and thus the delay chain cut down. 3) The NTC phones operator A of the RTC 4a) and receives a phone call from Tampere STC at the same time. 3) the NTC suggests that train 165 should be cancelled; operator A points out that it is scheduled to continue to Turku, so this is not possible. The NTC agrees; he had not known this. The operator further explains that the 165 will be in Turku on schedule (when leaving to return to Helsinki). The NTC says that the delay-chain to Tampere should be cut in some way; they discuss shortly that the next train also continues from Tampere to Jyväskylä, and must thus be driven even if it is late. The solution remains open as they end the call. 364

361 4b) The NTC answers a call from the Tampere STC, who has heard the previous discussion. The NTS and STC discuss possible solutions; the STC makes a new suggestion that seems to be feasible, and the NTC says he will ask the operator; if the plan is denied, only then will he contact the STC again. 5) The NTC phones the RTC operator ( B answers) and passes on the suggestion; operator B also approves it, and decides to follow it through. 6) The decision creates several tasks for VR's RTC, and operators A and B immediately begin to make the required connections, and to carry out the tasks and actions. According to the division of work in the network, VR's RTC is responsible for deciding, in the case of continuous delay, which trains it will operate and which not, to stop the delay chain. Event 2 shows that the RTC operators, as well as the NTCs, are aware of the traffic situation and that the delay chain of trains must be cut. However, no obvious solution is detected, and because of the busy traffic situation, the RTC operators have limited time for planning. The NTC finally explicitly points out to the RTC that the delay problem should be solved, and makes a suggestion for solution, but this is not feasible. Next, event 2 presents a case in which creating a solution to the immediate problem requires action despite organizational borders or agreed divisions of responsibilities. For some four minutes, the STC and NTC form a team of two experts, using e.g. timetables and other sources of information to figure out a solution. Afterwards, the NTC explains the solution to the operator in the RTC, who agrees with the plan and decides it should be followed; this, again, follows the rules and division of the work of the network. 6 Discussion Finland has a long history of one state-owned railway organization taking care of all possible rail transport tasks. The new era of differentiated organizations of public services and business organizations has thus demanded a considerable effort in defining the new organizational borders, divisions of responsibilities and tasks, and in developing appropriate shared or organization-specific tools and work practices. The first event shows that this development has been successful: in the course of normal traffic situations, the actors of the network are able to follow the agreed division of work, decision procedures and information flows. We use the networking concept to refer to collaborative work according to these prescribed scripts. Using the model of activity system as a frame, networking preserves the agreed rules, roles and division of responsibilities in the network. Such a prescribed form of working can be supported through careful analysis of the work processes, information needs etc., in relation to the objective and outcome of the activity, and further developing the information systems, protocols and division of labour. The idea of enlarging the common information space (Fields et al. 2005) is a valuable conceptual tool for development. As event 1 also shows, some important information is not yet available through information systems and must be asked for; such systems could be shared in the network in the future. The second event, in contrast, shows a deviation of the agreed, official division of work. Instead of following the prescribed task divisions, the NTC and STC form a temporary team of two experts to create a solution to the traffic problem. This kind of collaborative work resembles the knotworking concept (Engeström 2008). Contrary to predefined teams, knots emerge rapidly due to an objectrelated necessity of immediate collaboration and use of expertise, and have no fixed form, members or central authority. Knotworking thus forms a new temporary organizational layer in the context of the network. As in event, a new subject (the actors of the problem-solving) is formed (emerges) around the object (situation requiring problem-solving), and the tools, rules and roles follow the needs of the situation, rather than those defined in the network. 365

362 Obviously, knotworking is also supported with appropriate information tools and accurate preknowledge of the situation as well as the normal course of the work in the network; shortly, with high-quality, extensive common information space and good understanding of the immediate and remote social environments (Farrington-Darby and Wilson, 2009) in the network. What is also needed is support for rapid, informal ways of organizing knots in the context of a more rigid network. Indeed, it is not possible to write guidelines for all the situations and conditions that shape rail traffic controllers' work, which means that people have to modify their actions. Weick and Sutcliffe (2007) suggest that reliable outcomes require the capability to sense in a stable manner and yet deal with the unexpected in a flexible manner. Therefore, prescriptions should support processes of understanding, evidence collection, and evaluation as well as variable processes for action. In summary, in the network of organizations contributing to traffic control, two different modes of collaborative work are needed: networking and knotworking. The safety critical nature of rail traffic control highlights the need to prepare for both modes, and, respectively, to develop appropriate tools and work practices for both. We also argue that actors should be aware of these modes in order to act appropriately in different traffic situations requiring collaboration. References: Engeström. Y From Teams to Knots. Activity-theoretical studies on collaboration and learning at work. Series: Learning in doing: Social, Cognitive & computational perspectives. Cambrdige University Press, New York. Engeström, Y Activity theory as a framework for analyzing and redesigning work. Ergonomics 43(7): Farrington-Darby, T., Wilson, J.R Understanding social interactions in comlex work: a video ethnography. Cognition, Technology & Work (2009) 11:1-15 Fields, B., Amaldi, P., Tassi, A Representing collaborative work: the airport as common information space. Cognition, Technology & Work (2005) 7: Weick, K. E. and Sutcliffe K.M Managing the unexpected. Resilient Performance in an Age of Uncertainity., John Wiley & Sons, Inc. 366

363 AGE-FRIENDLY SHIFT SYSTEMS - DO THEY EXIST? Härmä, Mikko1, Viitasalo, Katriina2, Puttonen, Sampsa1 1 Finnish Institute of Occupational Health, Helsinki, Finland 2 Finnair Health Services, Vantaa, Finland 1. Introduction Based on the age-related changes in circadian rhythms, we have hypothesized that rapidly rotating shift systems would fit better to older workers. Based on an intervention study (1), a very rapidly forward rotating shift system (Respect) became popular among elderly shift workers in an aircraft technical maintenance unit. 2. Objective The aim of the current study was to study the interaction of age with shift systems of different shift characteristics in relation to perceived sleep-wakefulness, mood and inflammation biomarkers. Accommodating working conditions facilitates the employment and work continuity of persons with disabilities or long-standing health problems. 3. Methods Based on an on-going cohort study of Finnair (participation rate 56%), a questionnaire and inflammation biomarkers (blood leucocytes and high sensitive CRP) were analysed among 895 male workers in two age groups (-44 or 45+). The shift systems analysed were 1-shift work (day work, n=473), 2-shift work (n=176), backward rotating 3-shift work (n=45), rapidly forward rotating 3-shift work (Respect, n=69) and "flexible" 3-shift work" (n=102). All shift workers were working in the same technical maintenance unit. 4. Results Based on chi-square tests, opinions on the positive or negative effects of the used shift systems on different aspects of perceived well-being depended strongly on shift system. Respect workers, and especially the older ones, reported less negative effects than the other 3-shift workers. Based on a 2-way analysis of variance, age had significant interactions with the used shift systems showing that higher age was related with more frequent insomnia, fatigue and blood leucocytes in all other shift systems except in Respect where older workers had fewer symptoms and lower leucosyte levels than younger workers. Sleep need increased according to age in all 3-shift systems but decreased in 1- and 2-shift systems. In general, the backward rotating group reported the highest amount of sleep complaints and blood inflammation markers but also the 2-shift workers reported a higher amount of sleep complaints than the day workers. 5. Conclusions Shift work and age were both associated with sleep and mood but the age trends were dependent 367

364 on shift rotation. The data thus does indicate that a rapidly forward rotating shift system is a more age-friendly one compared to two other 3-shift systems with different rotation. 6. References (1) Härmä M, Hakola T, Kandolin I, Sallinen M, Virkkala J, Bonnefond A (2006) A controlled intervention study of the effects of a very rapidly forward rotating shift system on sleepwakefulness and well-being among young and elderly shift workers. Int J Psychophysiology 59:

365 B4: PHYSICAL ERGONOMICS B4.1 Ergonomics and musculosceletal symptoms in VDU work - 10-year follow-up study Risto Toivonen B4.2 Attitudes to musculoskeletal disorders among staff and management - a review of common views and how to cope with them Göran Hägg B4.3 Tactile feedback to influence sitting behavior during office work Bas van der Doelen B4.4 Risk exposure assesment of dynamic wrist motions of a DHM manikin Ida-Märta Rhén 369

366 ERGONOMICS AND MUSCULOSKELETAL SYMPTOMS IN VDU WORK A 10-YEAR FOLLOW-UP STUDY Toivonen, R 1 and Ketola, R 2 1 Finnish Institute of Occupational Health, Helsinki, Finland; 2 Tampere University of Technology, Finland A questionnaire study was conducted among VDU workers in the same organization in 1998 and The average time spent on VDU work had risen from 41% to 55%, during the follow-up. In 2009, the workers were much more satisfied with the ergonomics of their workstations. However the prevalence of musculoskeletal pain and strain had increased. The use of recursive partitioning and decision trees showed that, to reduce musculoskeletal symptoms and strain caused by VDU work, more emphasis should be placed on the ergonomics of worksites, the quality of the work environment, and the employees ability to vary their worktasks. Keywords: decision tree, musculoskeletal strain, work environment 1. Introduction Good physical ergonomics is known to help reduce musculoskeletal symptoms in VDU work (Ketola, et al.,2002). In the scientific literature, the most commonly referenced factors affecting worksite ergonomics are the characteristics of chairs, surfaces, the positioning of input and pointing devices, and screen height in relation to the worker (Ketola, et al.,2004). In addition, psychosocial and organizational workplace factors, as well as opportunities to take breaks, should be taken into account when comprehensive ergonomics are defined. 2. Objectives The aim of this study was to investigate the prevalence of VDU workers' musculoskeletal symptoms and the factors affecting worksite ergonomics. The findings were compared with the results of a study conducted 10 years earlier in the same organization. In addition the method of recursive partitioning was used to visualize the effect of work-related and individual factors on musculoskeletal symptoms. 3. Methods 3.1. Participants In 2009, an online questionnaire was sent to 833 office workers, of which 137 participated in an ergonomic intervention study in (Ketola et al., 2002). The response rate in 2009 was 36% (n=303) (Table 1). Table 1. Characteristics of the office workers. Women % (n) Men % (n) Age (years) Height (cm) Body weight (kg) Work experience (years) Mean (Range) Mean (Range) Mean (Range) Mean (Range) 1998 (n=416) 53 (221) 47 (195) 48 (21 63) 170 ( ) 73 (40 135) 18 (0 37) 2009 (n=303) 56 (171) 44 (132) 48 (25 66) 171 ( ) 76 (40 151) 17 (0 45) 370

367 The questionnaires also included questions on musculoskeletal strain and pain. Strain after a usual workday during the preceding month (30 days) was assessed by a five-level scale ranging from 1 no strain at all to 5 very much strain. A manikin was used to define 17 anatomical areas. The questions on pain during the preceding month (30 days) and year (12 months) addressed the number of days with pain. The questions on pain during the preceding year had five categories: 0 days, 1 7 days, 8 30 days, >30 days but not daily, and daily. The questions about pain during the preceding month had four categories: 0 days, 1 7 days, 8 14 days, and almost daily Statistical methods The statistical analyses were carried out using the computing environment R, version (x). All of the analyses utilized nonparametric methods. To analyse the change in musculoskeletal strain from 1998 to 2009, the Mann-Whitney test was used. When the prevalence of pain was analysed, the responses to the pain questions were classified into no pain (0 day) and pain ( 1 days). The effect and importance of the independent variables on the outcome variables was determined using recursive partitioning, and the Party toolbox for the R was used for all the calculation and visualization needs. Especially the function ctree from the Party package was used to generate conditional inference trees. In general, recursive partitioning creates a decision tree where each observation, i.e., worker, falls into only one terminal node. Each terminal node is uniquely defined by a set of rules based on the independent variables. For each participant nine outcome variables were generated by averaging the responses to the pain or strain question over the larger anatomical areas and scaling the averages into the range 0 to 1. The variables for the areas of the right upper limb and the neck and shoulder area were defined as follows: Pain in the neck and shoulder area (during the preceding 30 days and during the preceding 12 months) included the questions on local and radiating neck pain and pain in the right and left shoulder. Strain in the neck and shoulder area included a total of five areas: neck, right and left shoulder, and right and left area between the neck and shoulder. Pain in an upper limb (preceding 30 days and 12 months) was a combination of four questions: pain in a shoulder, forearm, wrist, or fingers. Strain in an upper limb consisted of six areas: fingers, wrist, forearm, upper arm, shoulder, and area between the neck and shoulder. In the recursive partitioning, the independent variables were the questions related to psychosocial work factors, the dimensions of the worksites, and the time spent on different worktasks. In addition, other independent variables were chosen on the basis of studies by Korhonen, et al.,2003 and Tuomivaara, et al.,2008. In the VDU ergonomics intervention study by Tuomivaara et al., it was shown that perceived competence in computer use predicted strain in the upper part of the body. Therefore, the variables from the questionnaire assessing the certainty of using computer programs and difficulties with controlling computers were selected as independent variables. 4. Results 4.1. Musculoskeletal strain and disorders From 1998 to 2009, the musculoskeletal strain and symptoms reported by the workers had increased, specifically in the right upper limb. In 2009, the men reported significantly more strain in areas of the right upper limb (fingers, wrist, forearm, and upper arm, p<0.01) and lower back (p<0.05) than in The women had more strain 371

368 in the right wrist (p<0.01) and right fingers (p<0.05). There was no reduction in strain in any anatomical area. The prevalence of musculoskeletal pain during the preceding 30 days and 12 months is presented in Tables 2 and 3. The data are given by year, gender, and age groups. Pain was studied in 11 anatomical regions. Table 2. Prevalence of musculoskeletal pain (%) during the preceding 30 days by year, gender, and age group. The differences between the groups were tested with the exact χ2-test. The statistical significances between the groups are indicated as * (p < 0.05), ** (p < 0.01), and *** (p < 0.001). Women Men < 45 years 45 years < 45 years 45 years p p1 p2 p p p1 p2 p3 Neck (radiating) * ** Neck (local) Right shoulder ** Left shoulder Right forearm * * ** Left forearm ** *** Right wrist * ** ** Left wrist ** Right fingers ** * *** * Left fingers *** Lower back * * p1 = Statistically significant difference in the prevalence of pain between the years 1998 and p2 = Statistically significant difference in the prevalence of pain in 1998 between the age groups of <45 years and 45 years. p3 = Statistically significant difference in the prevalence of pain in 2009 between the age groups of <45 years and 45 years. Table 3. Prevalence of pain (%) during the preceding 12 months by year, gender, and age group. Women Men < 45 years 45 years < 45 years 45 years p p1 p2 p p p1 p2 p3 Neck (radiating) * * *** Neck (local) Right shoulder ** ** * ** Left shoulder * Right forearm * *** Left forearm ** *** Right wrist * * ** Left wrist *** Right fingers * * ** ** Left fingers *** Lower back p1, p2, and p3 as indicated in the Table 2. During the 10-year follow-up, the prevalence of lower back pain during the preceding 30 days decreased from 61.1% to 47% among the older women ( 45 years). This was the only statistically significant decrease in pain prevalence from 1998 to In 1998, the older women had a higher pain prevalence in four areas (neck (radiating), right shoulder, and left and right forearm) than the younger women (<45 years) had. For the men, there were no significant differences in pain prevalence between the age groups. However, during the follow-up, the prevalence among the older men increased significantly in 6 and 8 of the 11 regions (preceding 30 days and preceding 12 months, respectively) 372

369 4.2. Work content The average time spent on VDU work had risen 14%, from 41% to 55%, during the follow-up. During this same period, the time spent manually writing had decreased by the same amount, to about 8% of the worktime. In 2009 the workers spent about 9.8% of their worktime in meetings, which was about 1% less than in In 2009 the workersts felt that time pressure at work had decreased and control over the order of one's own work had increased Workstation ergonomics and physical work environment Since 1998 the satisfaction with the physical work environment (local lighting, indoor climate, and ambient noise) had decreased, whereas satisfaction with the furniture and worksite settings had increased (Table 4). Table 4. Average ratings for factors affecting workstation ergonomics and the physical work environment. The factors were rated on a scale of 1 to 5 (1=good, 5=poor). The statistical significances between the years are indicated as * (p < 0.05), ** (p < 0.01), and *** (p < 0.001) (n= ) (n=98 301) (n= ) (n=98 301) Ambient lighting Placement of keyboard *** Local lighting * Computer mouse Temperature *** Placement of mouse *** Quality of air *** Placement of screen *** Ambient noise *** Size of screen *** Size of workroom ** Visibility of characters on screen *** Work chair Document holder *** Work desk * Usability of most often used ** Keyboard computer program 4.4. Recursive partitioning and decision trees For descriptive purposes, two of the generated decision trees are presented in Figure 5 and Figure 6. In Figure 5 the study population is classified into subgroups on the basis of the strain in the right upper limb. The algorithm was stopped after the fourth level of decision. Each participant falls into one terminal node, and each terminal node can be uniquely defined by a set of rules. In the figure each terminal node includes the box plot of the distribution of the dependent variable, i.e., strain in the right upper limb. In the tree the first split (node 1) was made for the value of the compound variable "ergonomics of the workstation". Its value ranged from 1 to 5, where value 1 was considered good and value 5 was poor. 373

370 Figure 5. Decision tree for strain in the right upper limb (n=303); p-values are visible for each decision node. When the distribution of the outcome variable (strain in the right upper limb) is considered, nodes A and B are the most favourable (low strain), and nodes X and Y are the least favourable (high strain). The subgroup falling into node A consisted of those who were happy with the ergonomics of their workstation (node 1) and considered their work ability to be good (node 2) and the ergonomics of their workstations to be even better (node 10). They were 44 years old or younger (node 11). On the other hand, the subgroup in node Y was somewhat satisfied with the ergonomics of their workstations (node 1), but they considered their work ability (node 2), as well as the usability of the most often used computer program (node 3), to be poor. In addition, they felt mental stress on the days when they answered the questionnaire (node 4). Node 14 is associated with an interesting rule in that the variable "break VDU" indicates whether the worker was afraid of breaking some device or accessory when working with a VDU. In Figure 2, the study population is divided into subgroups according to pain in the neckshoulder area in the preceding 12 months. The workers in subgroup X had the highest prevalence of neck-shoulder pain. They rated their work environment as poor (node 1, dichotomous variable "physical work environment"), they had suffered from depression at least sometimes (node 2), and they had to work fast and efficiently to keep up with their projects. On the contrary, the workers in subgroup A had much less pain in the neck-shoulder area, they rated their work environment as good, they had no mental stress, and they were non-smokers. 5. Conclusions This questionnaire study was conducted among VDU workers in the same organization in 1998 and Although the amount of VDU work had increased from 1998 to 2009, in 2009 the workers felt that time pressure at work had decreased and control over the order of one's own work had increased. In addition, in 2009, the workers were much more satisfied with the ergonomics of their workstations. However the prevalence of musculoskeletal pain and strain had increased from 1998 to The use of recursive partitioning and decision trees showed that, if musculoskeletal symptoms and strain caused by VDU work are to be reduced, more emphasis should be placed on 374

371 the ergonomics of worksites, the quality of the work environment, and the employees ability to vary their worktasks in order to break down long-lasting keying and mousing tasks. Figure 6. Decision tree for pain in the neck-shoulder area in the preceding 12 months (n=303). 6. References Ketola, R., Toivonen, R., Hakkanen, M., Luukkonen, R., Takala, E., & Viikari-Juntura, E. (2002). Effects of ergonomic intervention in work with video display units. Scandinavian Journal of Work, Environment & Health, 28, Ketola, R., Toivonen, R., Luukkonen, R., Takala, E., & Viikari-Juntura, E. (2004). Expert assessment of physical ergonomics at video-display unit workstations: repeatability, validity and responsiveness to changes. International Archives of Occupational and Environmental Health, 77, Korhonen, T., Ketola, R., Toivonen, R., Luukkonen, R., Hakkanen, M., & Viikari-Juntura, E. (2003). Work related and individual predictors for incident neck pain among office employees working with video display units. Occupational and Environmental Medicine, 60, Tuomivaara, S., Ketola, R., Huuhtanen, P., & Toivonen, R. (2008). Perceived competence in computer use as a moderator of musculoskeletal strain in VDU work: An ergonomics intervention case. Ergonomics, 51,

372 ATTITUDES TO MUSCULOSKELETAL DISORDERS AMONG STAFF AND MANAGEMENT A REVIEW OF COMMON VIEWS AND HOW TO COPE WITH THEM Hägg, Göran M School of Technology and Health, Royal Institute of Technology (KTH) Alfred Nobels Allé 10, SE Huddinge, Sweden When risks for musculoskeletal disorders (MSD) are identified at a work place the ergonomist has to cope with several more or less established attitudes and myths towards MSD to be able to attain a real change of working conditions and reduce identified risks. In this paper some common attitudes and myths are reviewed and measures to overcome them are suggested. The basis for this paper is mainly own experiences from projects in the red meat businesses and grocery stores. Keywords: ergonomic change, communication, attribution 1. Introduction There is today well established knowledge about risk factors for musculoskeletal disorders (MSD) in working life. A well educated and experienced ergonomist can mostly identify these factors and suggest relevant measures to avoid them. However, if these suggestions shall be meaningful, staff and management must accept them and act accordingly. Several more or less established attitudes and myths can jeopardize such action. These attitudes may be grounded in a specific company culture or more general attitudes in society. If preventive work is to be successful, an ergonomist must be aware of such attitudes and have strategies to cope with them. In this work frequent common attitudes are reviewed and possible strategies to deal with them are discussed. 2. Method The material constituting the basis for this paper is own experiences from previous applied field research, mainly in the red meat industry (Hägg et al., 2007) and concerning checkout cashiers (Kihlstedt & Hägg, 2011). In the red meat project semi structured interviews were performed with 58 meat cutters and 50 checkout cashiers answered a questionnaire regarding working conditions and MSD. Management views were collected by informal contacts with management in the two projects above and as reported by Nordlöf et al., Results and discussion of findings An obvious initial observation is that there are major differences between management and employees, also confirmed by Nordlöf et al., Hence the results are presented in two major groups, management and employees. 376

373 3.1 Management Management has its main focus on company core values. The work environment is most often not a core value in itself. Thus these issues have to be discussed in terms of economic gains/losses, production quality, productivity and company public image Economy Profitability is a major goal for most enterprises. Often measures for ergonomic changes are seen as pure costs which shall be avoided. It is then essential for an ergonomist to point out hidden gains associated with ergonomic improvements. Sick leave is often a consequence of poor ergonomics. Costs for sick leave are according to own experience often not paid attention to by management, especially when it comes to hidden costs not directly seen. For middle management in large corporations it may also be fruitful to break down these costs and relate them to the economy of a specific department. For more information regarding such issues see Rose & Orrenius, Quality There are several investigations showing a relation between poor ergonomics and product quality flaws (see Hägg, 2003, for examples). Since quality is a core value in many companies, especially when it comes to high-tech products like cars et cetera, consequences for quality caused by poor ergonomics may be an useful argument for better working conditions Goodwill in the society There is today a trend of increasing awareness among companies regarding the importance of company goodwill in the society. The concept Corporate Social Responsibility (CSR) is also gradually becoming more important. In cases where there is a risk of reports in public media about poor working conditions this may be a chance to argue for better working conditions. 3.2 Employees Employees have a personal interest to avoid MSD but this interest is often in conflict with income expectations, especially when employees work on piece rate. Other attitudes discussed are denial of MSD risks, often related to young employees feeling of invulnerability and corporate culture including traditions like MSD are inevitable in this trade. Attribution of own and/or workmates MSD is an important aspect. Erroneous attribution is an ignorance to consider in this context Income versus MSD It is a basic striving for an employee to maximize the income. One obvious way to do this is to increase own productivity. The most common situation is when wage-conditions involve piece rate which give the employee good possibilities to increase income by higher work pace. However, there is scientific evidence from many trades that there is a positive relation between high pace and MSD risks. This problem is most salient in younger employees. Older employees often have learned their lesson the hard way and have already contracted MSD. 377

374 To prevent MSD caused by too high work pace is a pedagogic challenge for the ergonomist. A major measure is to assure that these issues are properly addressed in the education and training of apprentices. It is often fruitful to engage older experienced employees in this process. If the management is aware of the problem, another way may be to set upper limits on individual daily production. These limits may even be negotiated individually depending on personal skill and experience Denial of MSD risks Even if the staff is well informed about MSD risks (which certainly is not the case in all work places) there are many reasons for why they are ignored. A common attitude, especially among young employees, is that this will not happen to me since I am so strong and skilled. Again, proper education of newly employed is essential and this information may have to be repeated on regular basis. Examples from their own environment are recommended and the experience of older workers should be brought out Corporate culture In some trades various notions and myths may be found like pain is inevitable in this trade or if you don t have pain you have not done a good job. If they are widespread, as was found in the red meat businesses in Sweden, they are hard to change in short time. A long-term broad information program is needed to cope with them Attribution A basic prerequisite for a worker to be able to take appropriate action when initial signs of MSD are experienced is to understand what type of exposure that causes the disorders. Especially at work at low level static loads and/or repetitive loads, employees are inclined to misjudge what exposure factors cause MSD. An example from own experience is check out cashiers who say that their shoulder/neck disorders are due to lifting of heavy objects. Objective observation reveals that these lifts occur infrequently and a much more likely causing factor is the repetitive manual handling of items and too long working periods. Again, appropriate education regarding existing risk factors is essential. In this case, also management may be unaware of risks and may need education. 4. Final discussion This short review only give some examples of hindrances which an ergonomist may encounter when trying to implement ergonomic changes. A general advice when it comes to convincing management and staff of the need of change is to learn as much as possible about their business and their general frames of reference and adapt the arguments accordingly. Identification and commitment are key concepts in this process (Åteg et al., 2005). Modern video techniques can today be easily applied at the work place to illustrate the message and improve identification (Kadefors and Forsman 2000, Vogel and Hägg, 2003). General instruction videos may be good but the message can often be rejected by responses like that does not look as our work place or we do this differently. 5. References Hägg, G. M Corporate initiatives in ergonomics - an introduction. Appl Erg 34:1,

375 Hägg, G.M., Vogel, K., Fröberg, J., Oxenburgh, M. & Åslin Hägg, E Bättre ergonomi inom svenska slakteribranschen (BESS) - slutrapport från ett forsknings och utvecklingsprojekt. (In Swedish) Arbetslivsrapport 2007:11, Arbetslivsinstitutet, Stockholm Kadefors, R. & Forsman, M Ergonomic evaluation of complex work: a participative approach employing video-computer interaction, exemplified in a study of order picking. Int J Ind Erg 25: Kihlstedt, A. & Hägg, G.M Checkout cashier work and counter design Video movement analysis, musculoskeletal disorders and customer interaction. J Ind Erg 41, Nordlöf, H., Wijk, K. & Lindberg, P. 2011, A comparison of managers' and safety delegates' perceptions of work environment priorities in the manufacturing industry. Human Factors and Ergonomics in Manufacturing & Service Industries. doi: /hfm Rose, L. & Orrenius, U Beräkning av arbetsmiljöns ekonomiska effekter på företag och organisationer - En översikt av ett urval modeller och metoder (In Swedish) Arbete och Hälsa 2006:18, Arbetslivsinstitutet, Stockholm Vogel, K. & Hägg, G. M TALE and other video techniques for teaching and evaluating ergonomics in red meat industry. Proceedings of IEA-2003, Seoul, Ergonomics Society of Korea. Åteg, M., Andersson, I. M. & Rosén, G Moveit - Motivations- och engagemangsskapande metoder i arbetsmiljöarbetet (In Swedish). Arbete och Hälsa 2005: 8, Arbetslivsinstitutet, Stockholm 379

376 TACTILE FEEDBACK TO INFLUENCE SITTING BEHAVIOR DURING OFFICE WORK van der Doelen, L.H.M. (1,2); Netten, M.P. (2) Goossens, R.H.M. (2,3); 1: BMA Ergonomics, The Netherlands; 2: Technical University of Delft, Applied Ergonomics and Design. The Netherlands, 3: Erasmus Universiteit Rotterdam, Department of Neuroscience, The Netherlands An office chair was developed that measures and logged sitting postures real-time. The biomechanical optimal supported posture for VDU work was used as a reference posture. Limits were set for the amount of time that the user would sit in other postures. A vibrating unit in the seat gave a signal to draw attention to crossing that limits. Twenty four subjects used this chair during six weeks of their regular office work. They were all considered VDU workers. All subjects were instructed about the best use of the chair and it s settings and about the technological features. There was a significant increase in the percentage of time in the reference posture five minutes before and five minutes after the vibrating signal. This increase was also significant with a ten minute time frame. It is concluded that tactile feedback can positively influence sitting behavior during VDU work. Keywords: posture guidance, chair design, VDU work. 1 Introduction In the last decades many jobs in the Western world have changed from physical, industrial or agricultural work to more knowledge and service work. A significant increase in work with at computers is observed. Most of these jobs are considered sedentary jobs. The total time that people perform these tasks is increasing as well (Parent-Thirion et. al. 2007). Despite an ongoing movement towards new ways of working, that claim more flexibility in time and place to work, most tasks are still performed while sitting on an office chair at a desk. The modern office chair is highly adjustable to the individual user. Many different models have entered the market. Biomechanical criteria for design of seats have been documented (Goossens et. al. 1995, Snijders 1995, Eklund 2008, Zacharkow 1988). It is believed that providing workers with ergonomic equipment can improve comfort and productivity in the office. And that his effect is enhanced by an ergonomic training and instruction program to raise awareness and knowledge in office workers (Robertson et. al. 2009) Although most office chairs are adjustable many users still find it difficult to achieve a comfortable and good work place. Vink et.al. (2007) demonstrated that many end users (63% in a study with 100 office workers) never adjust their chairs despite their self reported physical discomfort. Different sitting postures can lead to different levels of discomfort in specific body regions (Commissaris et. al. 2005, 2008). They suggest that we can use this knowledge (i.e. physical discomfort in different body regions) to deduce the period of time that people could maintain certain postures without high levels of discomfort. In relation to this, measuring and influencing sitting behavior in office chairs is becoming more and more an area of interest. However most studies the authors could find are still in a laboratory setting using complicated equipment. (Fenety et. al. 2003, Mutlu et. al. 2007, Tan et. al. 2001, Zheng et. al. 2010) In a funded design project by the European Union a new system was developed that can measure and log sitting postures real time in a specific type of office chair (Axia Office, BMA Ergonomics, NL). (European Fund for Regional Development , Smart Chair and Office Development Project). A biomechanical optimal supported posture for VDU work based on the findings of Snijders (1995) and Goossens (1995) was used as a reference posture. Limits can be set for the amount of time that the users sits in other postures. A vibrating unit in the seat can be activated automatically to draw attention to crossing that limits. These kind of signals were also proposed in a study by Zheng et.al.(2010) 380

377 The aim of this paper is to study the effects of feedback by the chair on the amount of time that the user is sitting in the reference posture, i.e. biomechanically optimal supported posture, compared to non-optimal postures. 2 Methods A field study using office chairs with measuring technology was done from October to December Subjects were employees of a large financial institute in Brussels, Belgium. They could be included in the study if they worked at least 3 days a week and worked with a computer more than 4 hours per day. They were not included if there was a history of musculoskeletal problems in the last 6 months. 2.1 Subjects Participants were 24 volunteers (12 females, 12 males) that worked on two different departments. The participants should perform their regular office tasks while using a measuring chair. Female participants had a mean age of 42 (sd 9.1). They had a mean height of cm (sd 6.4) and a mean body weight of 71.4 kg (sd 14.5). Male participants had a mean age of 46.5 (sd 10.5), a mean height of (sd 5.9) and a mean weight of 86.9 kg (sd 12.2). 2.2 Measuring (office) chair The chair calculates postures based on pressure values of sensors in the seat surface and back of the seat. Postures are calculated at 1 Hz and logged on the chair. The algorithm is part of product development and at this time only open for internal communication. The measuring system is fully integrated in the chair cushioning. Direct feedback is given by the chair by means of a vibrating signal in the seat, located under the right upper leg, towards the front edge of the seat. The signal consists of four short pulses within 4 seconds This signal is activated if the user is not sitting in a the reference posture for more than a preset amount of time during the preceding hour. A label showing the contours of the chair, is attached to the side front of the seat near the right leg. This label can show the dominant posture in the preceding hour by a corresponding configuration of LED s in the chair contours. By operating the label the user can switch to actual LED feedback of seat pressure to achieve the best supported sitting position. 2.2 Experimental Set-up Subjects used the chairs during 8 weeks. The first two weeks were considered a control condition to measure regular sitting behavior. During these first two weeks the subjects received a chair that measured their posture, but no instruction or feedback was given during that time. At the start of the study participants were informed in person about the protocol. They all signed informed consent. The office workers individually picked up their measuring chair. The chairs were calibrated at that moment to the individual pressure profiles in the reference position (figure 1, left) After calibration, chairs were handed over to the participants in a standard setting, so they had to adjust the chair to their personal preferences at their workplace. No further instructions were given. The chairs were measuring but didn t give feedback (no label attached, vibrating unit off). 381

378 Figure 1: Left: model) Reference posture for VDU work Right: Label for visual feedback of sitting postures (functional study At the start of the intervention condition the label was mounted to the chair for visual feedback about sitting postures. The vibrating unit was switched on to respond at the preset limit, i.e when the user was sitting less than 50% of the preceding hour in the reference posture. Users could check on the label (figure 1, right) what posture was dominant in the preceding hour and decide to change their posture. Feedback signals (vibration) were given at a maximum rate of once every hour. All participants received the same training instruction about chair settings and ergonomic workplace settings (e.g monitor height, desk height). The researchers collected the data from the chairs at times that the users were absent. 382

379 2.3 Data analysis Out of the data only those time intervals were selected in which the user was sitting on the chair 10 minutes before and after the vibrotactile feedback signal. The number of samples in a 10 minute time interval ST 10 min and the number of samples in a 5 minute ST 5 min interval that the user was sitting in the optimal posture before and after the vibrotactile feedback signals were used for statistics. Two hypotheses were tested: H0: ST 10, min, before = ST 10 min, after H0: ST 5, min, before = ST 5 min, after H1: ST 10, min, before ST 10 min, after and H1: ST 5, min, before ST 5 min, after A Wilcoxon Signed Rank test was performed with a level of significance of These hypotheses were tested using SPSS Results Due to technical issues, data of 2 participants chairs were unreliable and incomplete and therefore disregarded for analysis. Only one subject was, during the intervention weeks, sitting in the reference posture almost all of the time for more than 50%. Since this was the limit for the vibrotactile feedback signal, only few signals were given. This data was disregarded as well. Figure 1 shows the mean differences in sitting time in the reference posture before and after the vibrotactile trigger for 5 and 10 minute time frames (as a percentage of that time frame). It is clearly shown that most participants reach an increase in sitting time in the reference posture after the feedback trigger. Figure 1: Percentage of sitting time in the reference posture before and after a vibrotactile feedback signal given by the office chair. Mean values of 6 weeks of sitting are presented (n=21) for 5 and 10 minute time frames before and after the signal. Data of 21 subjects were used for statistical analysis. On average subjects got 50 feedback signals in 6 weeks (sd 21, range 18 to 111) within the selected 20 minute time frames. A total of 1044 paired samples was used for statistical analysis. 383

380 The Wilcoxon Signed Rank Test results showed that ST 10 min, after was significantly higher than ST 10, min, before (Z=-7.10, p (two-tailed) < 0.001). For the 5 minute time frame ST 5 min, after was significantly higher than ST 5, min, before (Z=-8.12, p (two-tailed) < 0.001). H0 was rejected for both test conditions.. During the time of this study participants used the experimental chair on average 18.5 hours per week (sd 4.4). A maximum of 34 hours per week was observed. During the control weeks, the mean percentage of sitting in the reference posture was 4,8% (sd 4,9%, range 0% - 17,3%). During the intervention weeks, the mean percentage of sitting in the reference posture was 11,6% (sd 11.7%, range 1.8% %). For the 5 minute time frames ST 5, min, before was on average 10.9% (sd 6.5). The ST 5 min, after was on average 15.0% (sd 7.7). For the 10 minute time frames ST 10, min, before was on average 11.4% (sd 6.9%). The ST 10 min, after was on average 14.1% (sd 7.2%). 4 Discussion Participants started the study after two weeks of a control situation. At the start of the intervention condition they received instructions about chair and workplace adjustments and use. Most participants improved their sitting postures significantly in the weeks after this intervention. The participants showed significant temporarily improvements in sitting postures after feedback triggers, that exceeded the overall mean improvement. This studies primary objective was to look at the differences in time in one (optimal) sitting posture. Changes in dominant postures from less optimal to another less optimal posture were not considered yet. Observation of individual data suggested in many cases a change in calculated posture after feedback signals. Data showed many situations where subjects decided to get out of the chair shortly after a feedback signal. These data were not considered in this specific test, but could be seen as healthy behavior, i.e. getting up after prolonged sitting. Some participants showed very low amounts of time in the reference posture during the whole study. This can partly be explained by incorrect calibration values at the start of the study. Another reason of large differences in sitting postures can be different task characteristics between subjects. We had no objective measure to verify this. This study is part of an ongoing design project. Functional models of measuring chairs will develop and become more accurate as the project progresses. This study showed that users can improve the sitting time in well supported positions within the same task characteristics. This could give a better comfort during the work day. Still many other postures are detected by the chair, suggesting that users have a natural behavior against postural fixity. Tasks that allow changes in postures remains one of the most important ergonomic criteria. A feedback system to guide ergonomic instructions about office chair use has positive effects on sitting postures. Further development is aiming at starting a dialog with end users of ergonomic office equipment based on data about actual use. This could be a novel way to enhance the effects of training and instruction. 5 References 1. Commissaris, D.C.A.M., Reijneveld, K., October Posture and movements during seated office work; results of a field study. In: Veiersted, B, Fostervold, K.J., Gould, K.S., (eds). Proceedings of the 37th Annual Conference of the Nordic Ergonomics Society. NES and NEF, Oslo, Commissaris, D.C.A.M., Blok, M., Bosch, T., Könemann, R., Bronkhorst, R.E., August Musculoskeletal discomfort during VDU tasks; input for a smart office chair. In: Helgadóttir, B., (Ed). 384

381 Proceedings of the 40th Annual Conference of the Nordic Ergonomics Society. NES and Vinnis, Reykjavík, Eklund J. In Kumar, S., (ed) Biomechanics in Ergonomics, 2008, 2nd edition, Boca Raton, CRC Press, chapter 24 biomechanics in work seating design, Fenety, A., Tingley, M, McLean, L, Harman, K, Putnam, C, Rickards, J, Crouse, J, and McLennan, A, Measuring sitting behaviour: the effect of a stressful typing task on posture and postural fixity, Proceedings of the International Ergonomics Association Annual Conference (IEA), Seoul, Korea, August 24-29, Goossens RHM, Snijders CJ, Design criteria for the reduction of shear forces in beds and seats. Biomechanics 1995, 28: Mutlu, B., Krause, A., Forlizzi, J., Guestrin, C., & Hodgins, J.K. (2007). Robust, Low-Cost, Non- Intrusive Recognition of Seated Postures. In Proceedings of 20th ACM Symposium on User Interface Software and Technology (UIST 07), Newport, RI. 7. Parent-Thirion, A., Macias, E.F., Hurley J., Vermeylen G., Fourth European Working Conditions Survey, Dublin: European Foundation for the Improvement of Living and Working Conditions Robertson, M.M., Amick, B.A., DeRango, K., Rooney, T., Bazzani, L., Harrist, R., and Moore, A., The Effects of an Office Ergonomics Training and Chair Intervention on Worker Knowledge, Behavior, and Musculoskeletal Risk, Applied Ergonomics, Vol. 40, No. 1, pp , Snijders CJ. Zitten op stoelen, werkvlakken en houdingsverval. Ch19. In: Frankel FH, Nordin M, Snijders CJ Biomechanica van het skeletsysteem. Lemma BV, Utrecht 1995, Tan, H.Z., Slivovsky, L.A., Pentland, A.P., A Sensing Chair Using Pressure Distribution Sensors, IEEE/ASME Trans. Mechatronics, vol. 6, no. 3, pp , Sept Vink, P., Porca-Seder, R., Page de Poso, A., Krause, F., Office chairs are often not adjusted by end-users. In: Proceedings of the Human Factors and Ergonomics Society (HFES) 51st Annual Meeting, Baltimore, Octobre CD ROM 12. Zheng, Y, and Morrell, J.B., A vibrotactile feedback approach to posture guidance. Haptics Symposium, 2010 IEEE, pages , mar Zacharkow, D. 1988, Posture, sitting, standing, chair design and exercise. (Springfield, USA.) 385

382 RISK EXPOSURE ASSESSMENT OF DYNAMIC WRIST MOTIONS OF A DIGITAL HUMAN MODEL Rhén, I-M 1, Hanson, L 2,3 and Högberg, D 1 1. Virtual Systems Research Centre, University of Skövde, Box 408, SE Skövde, Sweden 2. Department of Product and Production Development, Chalmers University of Technology, SE Gothenburg, Sweden 3 Industrial Development, Scania CV, SE , Södertälje, Sweden Software tools as Digital Human Modelling (DHM) has been designed to simulate and visualize the human work and to assess ergonomics conditions. No methods in commercial DHM software calculate time-dependent information, which is adequate in defining the relations between exposure and risk of disorders. The paper presents and discusses how an assembly task can be analysed with the help from a DHM-tool. Out comes from the study revealed that it is possible to generate output files with time-dependent wrist exposure data from a manikin in a DHM-tool. However, current evaluation methods do not take time-dependent information into consideration. Keywords: Assessment, Dynamic, Musculoskeletal, Exposure 1 Introduction Work-related musculoskeletal disorders (MSD) represent a major health problem in modern industrialized nations with considerable costs and impact on quality of life (EODS 2005). To address these concerns, an ergonomic evaluation of work and the workplace generally helps to identify and prevent risk factors for MSD. Frequently used assessment methods in the field of ergonomics such as RULA (McAtamney and Corlett 1993) and OWAS (Karhu et al. 1977) are based on physical observations and are scientifically developed and validated. In terms of the evaluation of movements that are of more definite importance, observation methods lack the precision and validity that direct measurement techniques can provide (Hansson et al 2001). From these direct measurement techniques, quantitative information from a variety of parameters can be collected and calculated. As part of more computer-aided development processes being utilized in industry, software tools as Digital Human Modelling (DHM) has been designed to simulate and visualize the human work and to assess ergonomics conditions (Chaffin 2001; Berlin and Kajaks 2010). The program generally includes standard evaluation methods such as OWAS and RULA (Chaffin 1997) even though some companies choose to customize the DHM tool by implementing their own company specific ergonomics methods and standards (Svensson and Sandström 1995; Högberg et al. 2008). However, today's DHM tools are mainly used to provide information about static postures that are represented as the "worst case" scenarios. No methods in commercial DHM software calculate time-dependent information such as angular velocity, repetitiveness and fraction of time in non-neutral position, which is adequate in defining the relations between exposure and risk of disorders. This aspect is crucial in the evaluation of the effect of a change in workload due to an intervention (Wells et al. 2007). Thus, for the calculation of exposure data there is a need of ergonomics evaluation methods that take dynamic aspects into consideration. 2 Objectives The present paper presents and discusses how an assembly task can be analysed with the help from a DHM tool. From a predefined assembly sequence, wrist exposure dynamic data is obtained from the DHM tool. This data is then analysed for its criticality related to risks for developing MSD. The DHM tool IMMA (Hanson 2011) is used for the illustration of the assessment process. 3 Methods 386

383 3.1 DHM based assessment process The process includes three major steps: 1) export of manikin wrist movement data, 2) analysis of data stream and calculation of exposure data, 3) estimation of risks for MSD. 3.2 Data input for the illustrative case Wrist angle data for flexion and deviation of the right and left hand were collected from a male manikin performing a 9 seconds long assembly task of a tunnel console in a car. The movements were generated by a motion path created by an industrial path solution (IPS) planner finding a collision free way (Bohlin et al 2011). Quantitative data (25 Hz) was produced by IMMA software tool, which also exported and transcribed wrist angle data to an XML worksheet. Further calculations regarding time-sensitive variables were performed in an Excel software program. 3.3 Evaluation concepts used for ergonomic exposure assessment For evaluation of the data in the illustrative case following concepts were used: RULA (McAtamney and Corlett 1993), Exposure Variation analysis (EVA) (Mathiassen and Winkel 1991) and percentiles (Jonsson 1988). The RULA method, which includes thresholds for exposure values, assesses workload through action categories created by risk parameters. The actions are displayed by a traffic light system (red, yellow and green) and the exposure conditions are classified according to obviously hazardous (e.g. flexion/extension >15 ), may be hazardous (e.g. flexion/extension 0-15 ) or imply negligible risk (e.g. flexion/extension/deviation 0 ) (Lämkull et al. 2008). The EVA-model illustrates exposure data as a function of time. A two-dimensional diagram expresses the work by a continuous exposure variable divided into a number of classes and a second variable (duration) divided into subgroups. By this, the data exposure can be demonstrated as the cumulative relative duration within a given exposure class. This study uses an evaluation model where RULAs thresholds for exposure are used in combination with the variable duration in a modified EVA table. For RULAs neutral position (0 ) to be useful for identification, this exposure threshold is modified to an extended range of 0 to 1 degrees in all deviation planes. 4 Results First, the study revealed that it is possible to generate output files with time-dependent wrist exposure data from a manikin in DHM tool. These files are similar to those obtained when using electrogoniometer equipment and related software, i.e. the files display wrist angle data at each sample being captured. Output from the analysed data file showed that there were no major variations in wrist positions during the work sequence. In ulnar/radial plane, the wrist did not deviate from the neutral position at all and in flexion/extension plane, an angle of approximately 35 flexion was carried throughout the task. Angel velocity (ranged 0 /s to 55 /s) exposed a median velocity of 2.0 /s and 95 th percentile showed 10.2 /s. Acceleration variables were not calculated as the program of today is based on binary velocities, i.e. it currently does not offer any functionality for smoothing out speed alterations. Table 1: Right wrist angle Table 2: EVA/RULA: Right wrist angle distributions, set up exposure presented in percentiles. through EVA model and based of RULA limits for exposure angles. Percentile Range Sequence duration 1 th 29.7 Posture interval All 5 th 33.1 Flexion > th

384 95 th 38.5 Neutral th 39.2 Extension > All The values in the cells represent the percentage of total time spent in a specific posture (row) and in sequences of a specified duration (column) 5 Discussion The illustrative case, which demonstrates a short working sequence, displays a wrist work position that is more or less static. Moreover, the work task is performed in an awkward position resulting in flexion angles of extreme distributions. Although the task involves an extreme posture of the wrist, it could not be equated to contributing MSD if the motion is infrequently performed. In addition, the duration of the task is relatively short. But one might wonder how the situation would be if it is a regular procedure, which can be in an industrial assembly context. In this study, it has been chosen not to include the variable force in the ergonomic consideration. However, if it were, the stress and the discomfort on the wrist would increase markedly (O Sullivan and Clancy 2007). The usefulness of RULAs concept may be questioned in the assessment of dynamic work. According to RULA, all deviations from neutral position may be deemed as hazardous, the larger deviation the more hazardous it is. However, this line of reasoning may be too strictly in terms of time-dependent measurements. When a dynamic work sequence is assessed, the evaluation becomes more complex as more aspects must be taken into consideration. It is also important to distinguish between the hazard (a condition e.g. an extreme flexed position) for MSD and the exposure (the duration, repetition, level of force of the risk) when discussing what actually will cause MSD. A wrist that reaches its range of motion relatively rarely represents a small risk of developing MSD. It may even be regarded as beneficial to reach extreme postures for short periods as they implies so called "stretch breaks" (Delleman et al. 2004). Repetitivity is a parameter often mentioned as the major contributor of development of MSD (Kilbom 1994, Thomsen et al. 2007). Nevertheless, it is unclear how often a movement must be repeated for classification as hazardous. A variety of approaches are used in attempts to measure the repetitivity. Marras and Schoenmarklin (1994) believed that the variable acceleration in the flexion/extension plane was the most appropriate discriminator between groups of high or low incidence of wrist MSD. By the use of potentiometers to measure wrist acceleration peaks among industrial workers, Marras and Schoenmarklin compared the cumulative values with the incidence of registered wrist Cumulative traumatic disorders (CTD) and found a good conformity. In a similar way, Hansson et al. (2009) considered wrist angle velocity as a discriminator for MSD. This was confirmed by a study based on velocity and electromyography measurements of the wrist in flexion/extension and prevalence studies of wrist and elbow disorders. Hansson et al (2009) also reflect that the obtained values are in consistent with risk group classifications, -low risk group (median velocity of 11 /s or a mean velocity of 29 /s) and high-risk group (median velocity of 23 /s or a mean velocity of 42 /s) stated by Marras and Schoenmarklin (1993). Hansson et al. (1996) used a power spectrum analysis to calculate the repetitive aspect. The authors claim that their method enables measuring of more complex movements such as variability in frequencies. To reduce the risks of developing MSD, a change of exposure level across time is recommended. More detailed guidelines about how much and how often a particular exposure should be changed, is yet still unknown (Mathiasen 2006, Kilbom 1994). At present, uniform definitions regarding variable terms and metrics for risk exposure are lacking (Kilbom 1994, Berlin and Kajaks 388

385 2010). This in combination with the rough boundaries of existing risk predictors, as well as the complexity that follows with a dynamic assessment, leading to shortcoming in how the work should be evaluated. For directly measurement methods to be effective and able to fulfil their purposes, detailed guidelines requires for assessment of the risk variables. Moreover, these should be provided with additional class divisions so that a greater sensitivity could be achieved. 6 Acknowledgement This work has been possible with the support from the Swedish Foundation for Strategic Research/ProViking and by the participating organizations. This support is gratefully acknowledged. 7 References Bohlin, R., Delfs, N., Hanson L., Högberg, D., Carlson, J.S Unified solution of manikin physics and positioning. Exterior root by introduction of extra parameters. Proceedings of DHM 2011, First International Symposium on Digital Human Modeling, France, June 2011, ISBN Berlin, C., Kajaks, T Time-varying Ergonomics Evaluation for DHMs: a Literature Review. International Journal of Human Factors Modeling and Simulation 1(4): Chaffin, D. B Development of Computerized Human Strength Simulation Model for Job Design. Human Factors and Ergonomics in Manufacturing 7: Chaffin, D.B Digital Human Modeling for Vehicle and Workplace Design. Society of Automotive Engineers, Inc., Warrendale, USA. Delleman, N. J., Haslegrave, C. M., Chaffin, D, B Working postures and movements: Tools for evaluation and engineering. ISBN: / ) European Occupational Diseases Statistics (EODS) Eurostat working papers. Population and social conditions 3/2000/E/No 19. Reference metadata on occupational diseases, compiling agency: Statistical Office of the European Communities. Hanson, L., Högberg, D., Bohlin, R., Carlson, J.S IMMA Intelligently Moving Manikins Project Status Proceedings of DHM 2011, First International Symposium on Digital Human Modeling, France, June 2011, ISBN Hansson, G-Å., Balogh, I., Ohlsson, K., Rylander, L., Skerfving, S Goniometer measurement and computer analysis of wrist angles and movements applied to occupational repetitive work. J Electromyogr Kinesiol 6(1): Hansson, G-Å., Balogh, I., Ohlsson, K., Skerfving, S Measurements of wrist and forearm positions and movements: Effect of, and compensation for, goniometer crosstalk. J Electromyogr Kinesiol 14(3): Hansson, G-Å., Balogh, I., Ohlsson, K., Granqvist, L., Nordander, C., Arvidsson, I., Åkesson, I., Unge, J., Rittner, R., Strömberg, U., Skerfving, S Physical workload in various types of work: Part 1. Wrist and forearm. International Journal of Industrial Ergonomics 39:

386 Jonsson, B The static load component in muscle work. Eur. J. Appl. Physiol. 57:hang Högberg, D., Bäckstrand, G., Lämkull, D., Hanson, L., Örtengren, R Industrial customisation of digital human modelling tools. International Journal of. Service Operations and Informatics 3: Karhu, O., Kansi, P., Kuorinka, I Correcting working postures in industry: A practical method for analysis. Applied Ergonomics 8: Kilbom, Å Repetitive work of the upper extremity: Part II the scientific basis (knowledge base) for the guide. International Journal of Industrial Ergonomics 14(1-2): Lämkull, D., Berlin, C., Örtengren, R DHM - Evaluation Tools. In: Handbook of Digital Human Modeling: Research for Applied Ergonomics and Human Factors Engineering. Duffy VG (Ed.). Taylor & Francis, CRC Press. ISBN Marras, W. S., Schoenmarklin, R. W Wrist motions in industry. Ergonomics 36(4): Mathiassen, S-E., Winkel, J Quantifying variation in physical load using exposure-vs-time data. Ergonomics 34(12): Mathiassen, S-E Diversity and variation in biomechanical exposure: What is it, and why would we like to know? Ergonomics 37: McAtamney, L., Corlett, E. N RULA: a survey method for the investigation of work-related upper limb disorders. Applied Ergonomics 24(2): Occhipinti, E OCRA: a concise index for the assessment of exposure to repetitive movements of the upper limbs. Ergonomics 41(9): O Sullivan, L., Clancy, P., Guideline threshold limit values (TLVs) for discomfort in repetitive assembly work. Human factors and ergonomics in manufacturing 17(5): Thomsen, J. F., Mikkelsen, S., Andersen, J. H., Fallentin, N. Loft, I. P., Frost, P., Kaergaard, A., Bonde, J. P., Overgaard. E Occup Environ Med 64: Schoenmarklin, R. W., Marras, W. S., Lerurgans S. E Industrial wrist motions and incidence of hand/wrist cumulative trauma disorders. Ergonomics 37(9): Svensson, I., Sandström, R BUMS: Belastningsergonomisk Utvärderings Mall Saab, Produktion. Saab Automobile, Trollhättan, Sweden. Wells, R., Mathiassen, S-E., Medbo, L., Winkel, J Time - a key issue for musculoskeletal health and manufacturing. Applied Ergonomics 38(6):

387 C4: NORDIC SUPERVISION NETWORK C4.1 The Danish Working Environment Authority's new special surveillance efforts Camilla Madsen C4.2 Communication ergonomics supervision in Sweden Christina Jonsson C4.3 The project: working together for a better work Environment Eldri Kirkesola 391

388 THE DANISH WORKING ENVIRONMENTS AUTHORITY S NEW SPECIAL SURVEILLANCE EFFORTS Madsen, Camilla Aunsholm The Danish Working Environment Authority The Danish Labor Inspectorate shall in the future conduct intensified supervision in the form of special initiatives within attrition threatened industries. The main focus of the supervision is dialogue and guidance. Businesses will be visited over several days. Companies thus have time to make an effort to improve the working environment. In the new initiatives The Labor Inspection will try to increase the focus on a holistic approach, specifically by using the so-called biopsychosocial frame of reference. MSD is one of the priority health problems appointed by the Government and based on MSD Tripartite discussions, the biopsychosocial frame of reference is included as an appropriate basis for a strengthened effort against MSDs. Keywords: Danish WEA, Special Surveillance Effort, MSD, Biopsychosocial 1. Introduction The political agreement reached in the spring of 2006 on the future prosperity, welfare, and investments implies that the Danish Labor Inspectorate in the future shall conduct intensified supervision in the form of special initiatives within attrition threatened industries. In 2010 the last operation, in light of the 2006 agreement, was implemented. In 2009 the parties behind The Prevention Fund, which besides the government (Liberals and Conservatives) counts the Social Democrats, Danish People's Party and the Radical Left, formed an agreement to renew The Prevention Fund. This led to the development of a new concept/method of specific supervisory interventions which is to be launched in The Danish Working Environments Special Surveillance Efforts Continue The Danish Working Environments special surveillance efforts in the attrition threatened industries will be continued after 2010 with more focus on dialogue and guidance. Experiences from previous efforts have been used to develop the new concept/method with greater focus on assistance, dialogue-based guidance and so-called prevention packages. An amount of 50 million Danish kroner is annually set aside to the Labor supervision from 2011 to 2014 so that the new concept/method can be conducted. 2.2 Prevention Packages Companies are offered so-called prevention packages, these prevention packages are pre-defined projects that companies can apply the Prevention Fund to fund. Prevention packages also help the company to plan and implement the project. It will especially help small firms to apply for funding and implementing a project. 2.3 Surveillance Method The new special surveillance efforts, is based on a dialogue with companies. The special surveillances are based on the expectation and confidence, that each company via the help and guidance from the Labor Inspectorate will work with their working environment and solve any problems they might have. This method also implies, that working environment problems that the companies themselves have not been able to identify and solve, will be taken care off. The Labor 392

389 Inspectorate will not leave a company if there are safety problems that pose a risk to health and safety. Businesses will be visited over several days with more time between visits. Companies thus have time to even make an effort to improve the working environment. First visit: The first visit is purely a guiding visit on musculoskeletal disorders (MSDs) and psychological work environment (although if necessary, prohibition and immediate injunction will be given). On the visit, The Labor Inspectorate has a dialogue with the company where the focus is on the safety and health working environment. This is done through a discussion of what works well and less well in the work environment, and how the company can continue working with MSDs and psychological work environment. On the visit the Labor Inspectorate also guide about prevention packages. Second visit: A second visit will be implemented within a reasonable time period, which can be up to several months. On this visit The Labor Inspectorate will again have a dialogue with the company on MSDs and psychological work environment. The Labor Inspectorate also implements a genuine oversight of the ergonomic and psychosocial work environment on this visit and will give decisions if it finds significant safety problems. The Labor Inspectorate also takes part in a dialogue with the company on how the company can work with its safety problems. Holistic approach In the new initiatives The Labor Inspection in particular will try to increase the focus on a holistic approach, specifically by using the so-called biopsychosocial frame of reference. 3. The Biopsychosocial Frame Of Reference 3.1 Background In 2005 the government undertook a new emphasis on work conducted up to and including The Government appointed four priority health problems, including MSDs. As part of the prioritization of MSDs, The National Research Centre for Occupational Health launched two elucidation works and each would result in a White Paper. These two white papers should form the background for each phase of the tripartite discussions between the Labor Inspectorate and the social partners on how the efforts against MSDs could be strengthened. The first phase was about absence due to sickness and return to work, and the other was on risk factors for MSDs related to heavy physical work. The Tripartite discussions were completed in June 2010 with a unanimous recommendation to the Minister. Based on the discussions, the committee included the biopsychosocial frame of reference as an appropriate basis for a strengthened effort against MSDs. 393

390 3.2 Understanding In the understanding of the biopsychosocial frame of reference is based on the following figure (Figure 1). This refers to the fact that s MSDs may have different reasons that mutually influence and reinforce each other. E.g. employment, social relationships and personal resources: The biopsychosocial frame of reference is an appropriate basis for a strengthened effort against MSDs. It applies to actions aimed at prevention of MSDs and the prevention of the consequences of MSDs (e.g., absenteeism and lack of job retention and return to work). Within the biopsychosocial frame of reference MSDs and its consequences are understood, as the interaction between biological, psychological and social factors. This means that a specific problem, e.g. an employee who is at risk of getting or already have a sore back, will be resolved through the actions on several fronts simultaneously, both biological, psychological and social: Biological; in relation to assess the presence and extent of risk to health, such as heavy lifting, reaching distances and awkward postures. Including e.g. assessment of physical ability and performance. Psychological; relative to change of habits, health and illness behavior, fear-avoidance, awareness of individual options and coping. Social; relative to its safety, health, sickness absence, retention and promotion policies, collegial and managerial support, dialogue, influence and involvement, planning and organization of work and more. 394

391 COMMUNICATION IN ERGONOMICS SUPERVISION IN SWEDEN Jonsson C., Wiberg, V., Rosenblad T., Carlsson, R. Swedish Work Environment Authority Information is important for the Swedish Work environment Authority (SWEA) besides supervision and regulation. The stakeholders need to have knowledge to be able to create a good working environment. Therefore different actions have been taken by SWEA to intensify information and give tools to prevent risks for ill health and accidents. Key words: Information, ergonomics, supervision 1 Introduction Although Sweden in an international comparison has a fairly good work environment there is still need for improvements and innovations. A good work environment is not only about preventing ill-health and accidents but also a source for promoting health, productivity and business. A working life that includes everyone is an overall priority of the Swedish Government. A good work environment is important for this. The Government has an Action Plan for regarding politics for the work environment. The aim is to promote health and to not exclude people from work. The strategic priority areas in the Action Plan are: Risks and opportunities in the working environment Exclusion Competition and profitability Awareness and knowledge The Government has given SWEA extra money in the budget for for information and knowledge dissemination including information to foreign companies and workers in Sweden. Extended market surveillance and work with national and international standards are also prioritized. SWEA will make it clear to companies that the right conditions can increase profitability and productivity and reduce absenteeism due to illness. The vision of SWEA is that everyone wants to and can create a good work environment. To create a good work environment many actors should be involved not only employers, employees and safety delegates but also pupils, manufacturers, importers, suppliers, commissioners of building and so on. It also requires knowledge and and an attitude that a good work environment is important. Support to those employers who want to act correctly is important. Information adapted to the needs of each company on the website will facilitate the work. 2 Objectives 395

392 Systems to reduce risks in the work environment need to be improved through better regulation, advice and knowledge dissemination. To strengthen the information activities is an important task of SWEA. Measures for better health should be visible and new knowledge produced and disseminated. The role of the Occupational Health Services should be stressed. 3 Methods Knowledge dissemination has to be done in different ways with focus on different groups. Knowledge compilation is one of the main areas in developing new knowledge. Concrete actions undertaken or planned include: - SWEA will increase the efforts to promote and monitor the development of the Occupational Health Services - SWEA s educational role to develop and improve - Advice and assistance to small enterprises - Skills support of generational change for safety delegates. 4 Results 4.1 Interactive health and safety training E-learning has been developed on risk assessment (http://www.av.se/sam/) and on health and safety training in the construction industry (http://arbetsmiljoverket.learnways.com/courses/course78/template.htm). Also e-learning of ergonomics is being developed as well as e-learning of work environment issues for the health care sector. 4.2 Assessment tools Tools for identification of risks and tools for assessing risks are put on the website to be used by employers, employees and the Occupational Health Care Services. (http://www.av.se/checklistor/ ) 4.3 Information Web information directed to different focus groups is important. Film is an effective way to disseminate information, especially on ergonomics. A film on space requirements in the health care sector is on the website (http://www.av.se/teman/ergonomi/informationsmaterial/film/index.aspx). In the year 2011 there will be short instructional videos on ergonomic hazards and measures to prevent risks in order to show that correct load strengthen the individual, the company and the society. Films are used also in internal courses. Brochures and power point presentation on ergonomics are available and free to use (http://www.av.se/teman/ergonomi/informationsmaterial/oh-serie/). A simple and comprehensible language is employed. Apps are another issue in the prevention of a good work environment that can be used more (http://www.av.se/teman/buller/app/ ). 4.4 Cooperation Cooperation between the authority and social partners is going on in different sectors. It is important to be cognizant of the expectations of the stakeholders. In the retail sector there has been a development 396

393 regarding ergonomics with demands of refrigerators. Cooperation has taken place between different organizations with the purpose to development a website on cleaning (http://www.alltomstad.se/). 4.5 Knowledge compilation SWEA has been instructed to spread information and knowledge in selected areas and will publish a number of knowledge reviews. On the website there is a knowledge compilation on voice ergonomics (http://www.av.se/aktuellt/kunskapsoversikt/rostergonomi/ ). Voice problems are common in special groups that use their voice as the main tool to do the work for example teachers, consults and actors. Another knowledge compilation on ergonomics will be published this autumn. 5 Discussion The vision that everyone wants to and can create a good working environment includes rules, information and inspections. The rules should be understandable and useful to all stakeholders. In the field of ergonomics there is still a great need for actions. Information that leads to action should be motivating, stimulating and activating. It should also be adapted to the needs of every workplace and focus on their problems. Information of today should not only focus on risks but also on opportunities. Information is also a part in the supervision activities. The inspectors have always given information when they inspect but this has now been clarified and stimulated. 6 References Work environment policy for jobs" summarizes the National action plan for the work environment , 397

394 THE PROJECT Vindsetmo, K. 1 and Kirkesola, E. 1 1 The Norwegian Labour Inspection Authority, Postbox 4720 Sluppen, N-7468 Trondheim, Norway The project was initiated by the Ministry of Labour in The name refers to 3 parties (the Authorities and the Employers and Employees Organizations), 2 sectors of working life, 1 common goal (a better working life). The purpose was to improve working environment through measures specially designed for each sector. 21 nursing homes and 10 meat processing plants participated and each appointed a project group consisting of representatives from employer, employees organizations and safety representatives. Two counsellors from the authorities were assigned to each project group. Better collaboration and clearer roles are among the results. Further results and examples are given in this article. Keywords: project, tripartite cooperation, nursing home, meat processing industry, musculoskeletal diseases Introduction In 2001 the tripartite cooperation agreement More Inclusive Working Life (IA) was signed in Norway. The three parties signing this agreement were The Authorities, the Employers Organizations and the Employees Organizations (hereafter referred to as the Organizations). The Authorities were represented by The Norwegian Labour and Welfare Administration (NAV) and The Norwegian Labour Inspection Authority (Arbeidstilsynet). The agreement s objectives are: reduction of sick leave, increased employment of people with reduced functional ability and extension of active employment after the age of 50. The project was initiated by the Ministry of Labour in 2006, as a special project connected to the IA agreement. Objectives The name refers to 3 parties (the Authorities and the Employers and Employees Organizations), 2 sectors of working life, 1 common goal (a better working life). The idea was to select two sectors with high numbers of sick leave days and/or a high number of workers not being able to work until normal pension age, and to try to find measures specially designed for each sector. Method 3.1 Organizing of the project The two sectors invited to take part in the project, were nursing homes for elderly people and meat processing plants. Contact was made to the relevant employers and employees organizations, and a committee was founded under the leadership of Arbeidstilsynet. For the nursing section KS (The Norwegian Association of Local and Regional Authorities) and HSH (The Federation of Norwegian Commercial and Service Enterprises) represented the employers, while Fagforbundet (Norwegian Union of Municipal and General Employees) and NSF (The Norwegian Nurses Organisation) represented the workers. For the meat processing industry, NHO (The Confederation of Norwegian Enterprise) represented the employers, and 398

395 NNN (The Norwegian Food and Allied Workers Union) spoke for the workers. NAV was also part of the committee. While all these different names and organizations may seem confusing to the reader, we have chosen to list them because they visualize both the main challenges and the great opportunities in this project. Consequently there were many people with various interests who had to find common ground for the development of the project. This required a long time to discuss and prepare the main project and it created some frustrations. But once common goals and methods of working were agreed on, the project had a good and broad foundation in Norwegian working life. The working environment challenges in the two sectors were quite different. To facilitate progress in the project, the main committee split up into two working groups, one for each occupational branch. Both groups agreed on two main goals: the strengthening of leadership and the strengthening of collaboration between employers/leaders and employees representatives and safety representatives. The nursing home group decided that their third goal would be to increase professional competence. The meat processing industry wanted their third goal to be increased attention on systematic health, environmental and safety activities. In July 2008 the main phase of the project was started. 21 nursing homes and 10 meat processing plants were recruited. The nursing homes were owned either by municipalities or by private organizations, while the meat processing plants had private owners or were part of an agricultural cooperation. One of the purposes of the project was to try out new methods of collaboration between the two authorities (Arbeidstilsynet and NAV). The counsellors ( good helpers ) from the two authorities were instructed always to work together, and learn as much as possible from each other in the process of supporting the nursing homes or plants. The assistance could be what each project group saw the need for: guidance, meetings, answering questions, facilitating contacts with other parts of for instance NAV, and so on. All the workplaces also had contact persons in relevant organizations. 3.2 Organizing of the project in each nursing home and meat processing plant Each nursing home and processing plant appointed a project group consisting of representatives from the employer, employees organizations and safety representatives. Two good helpers, one from NAV and one from Arbeidstilsynet, were assigned to each project group. Each nursing home and each meat processing plant used the three main goals to set up their own goals and activities to reach them. The project period was two years. The project groups were to receive the support and guidance they needed from the authorities involved (NAV and Arbeidstilsynet) and they could apply for economic funding of activities, up to NOK each. Results At the start- and endpoints of the project, working environment surveys were carried out in each participating nursing home and meat processing plant. The surveys were based on QPS-Nordic and were analyzed by the Norwegian National Institute of Occupational Health (Lau 2008, Hauge et al 2010). The Institute also evaluated the project together with the Institute for Labour and Social Research (Jacobsen et al. 2010). A project report has been made by Arbeidstilsynet (Utaaker and Hegdal, 2011). 4.1 Project results The outcome of the project in each individual workplace corresponded closely with the grounding and foundation it had inside its own organization. Some examples are listed below. Most of the workplaces asked for money to strengthen their leaders competence. In both the nursing sector and the meat processing industry leaders are mostly recruited from the ordinary workforce, but they are not necessarily given the knowledge and education they need to be really effective leaders. 399

396 Collaboration really works! When employees and safety representatives get the possibility to work closely with their leaders to reach a common goal, all parties report of a better working environment and more interesting jobs. The safety representatives often struggle to find their position in a workplace organization. Placing them in close collaboration with other employees representatives and leaders, as was done in this project, resulted in a clearer conception of roles for all parties. Help should be available when needed. When asked what had made the greatest difference in entering this project, most workplaces mentioned the help they had got from their counsellors from the authorities. It seems that Arbeidstilsynet s guiding role is not as well known as the controlling role. 4.2 Results with special reference to the prevention of musculoskeletal disease, an example from one nursing home Birkenes sykehjem is a nursing home with 46 elderly patients and 75 employees (equaling 42 full time jobs) in a small community in the south of Norway. The patients have cognitive and/or physical disabilities. The nursing home has one leader, but is organized in six units as regards the patients and practical work. The survey conducted at the start of the project indicated that Birkenes should work especially with these issues: fair management, empowering management and prevention of role conflicts. This work had already started in the nursing home, but the project allowed for further development. Some of the main activities are now: The leader, two representatives (nurse and nurse aide) and the safety representative meet every six weeks. The agenda is known to all employees and employees can ask their representative to bring up issues, practical matters etc. Minutes/summary is published in the nursing home. Lunchtime meeting every Wednesday for all employees (that can attend). There is general information, situation report from each unit and discussion/reflection on current issues. The leader always participates and ensures that issues are addressed and eventually decisions made. Staff meeting twice a year. Each unit sets up goals for their own work and working environment and report on achievement of previous goals. Administrative routines for hiring staff, changing of shifts, customizing of jobs, handling of conflicts etc are in active use. These measures and systematic development of professional work have given good results. The second survey carried out at the end of the project, showed higher scores. The main measures and results regarding prevention of musculoskeletal disease and better ergonomics are: Two employees have had special training in moving of patients and they give help and guidance to colleagues. Systematic use of ergonomic tools such as lifting aids and loyalty to agreed work techniques. Aid devices (such as lifts, wheelchairs) are always available and the night nurses are routinely made aware of where to find them. Counseling group for employees where they can discuss and reflect upon current issues. This leads to better coping. For employees with musculoskeletal disease, their job is customized as much as possible. The leader is apt to follow up on sick leave. She also encourages employees to inform her when they experience trouble at work. Her competence and experience in handling such matters play an important role. Issues are easily brought up in meetings and the leader makes sure that the issue is handled and solved. This does not mean that the leader handles all issues, but she provides time and resources for the employees working with them. 400

397 They employees are apt to give help to each other, also across the unit boundaries. The cooperation and the roles of the representatives are clearly defined and better known. The sick leave in 2010 was 4 % (12 % in 2008) and is so far in 2011 down to 3,5 %. A quotation from the leader: Coming together is the first step Keeping together is a step forward Working together is success 4.3 Results with special reference to the prevention of musculoskeletal disease, an example from a meat processing plant The surveys conducted in the meat process industry showed very interesting results. There was a correlation between the occurrence of various musculoskeletal pains and relation to immediate superiors. Finsbråten AS is a medium size, privately owned meat processing plant. As a result of the first survey, training of leaders was chosen as a local improvement area. Training was initiated, and leaders were closely followed by their superiors to ascertain that the new competence was put to use. Increased collaboration between leaders, employees and safety representatives proved a great success. All employees representatives were expected to take part in the same training as the leaders. This meant both parties got a common ground of knowledge and skills, which has proven very useful in developing all areas of the working environment, and in preventing and solving conflicts. Among measures implemented were: Leader training, including courses in conducting different kinds of meetings with employees and courses in the laws and regulations regarding working life. Routines clearly defining the roles of leaders and employees and safety representatives. More frequent staff meetings in each unit. Safety representatives are always responsible for part of the meetings, where working environment issues are discussed. Routines concerning social/psychological environment and etiquette - How do we want to behave towards each other at work. Increased attention on preventing injuries and sick leave. Routines concerning workers on sick leave, promoting job attendance when possible. More time allocated for the duties of employees` and safety representatives, and routines to make sure that they meet with leaders regularly. Finsbråten AS also wanted to work with ergonomic aspects. The issues of leadership and collaboration were addressed first, due to guidance from the good helpers. When a broad ergonomic survey finally was conducted, Finsbråten had an established internal control system which could cope with and follow up the results of that survey. A condition for receiving economical support from the project for the ergonomic survey was that this process should enable the plant to conduct their own surveys in the future. The measures were therefore defined as Training leaders and safety representatives to do this kind of survey Developing tools and routines for doing this on a regular basis. Numbers relating to sick leave are of course never conclusive in assessing the working environment. When sick leave is reduced gradually from 12% at project start to 3% at project end, it still is an impressive decrease. The final survey of all the meat processing industries showed that sick leave was reduced in 8 of 10 plants. The factors that had improved the most all had to do with relations between workers and their immediate superiors. References 401

398 Hauge, L.J., Skorstad, M.H. & Lau, B Sammen for et godt arbeidsmiljø. 3 Parter 2 Bransjer 1 Mål. Oppfølgningsundersøkelse: Sykehjemssektoren. Årgang 11. Nr. 9. Hauge, L.J., Skorstad, M.H. & Lau, B Sammen for et godt arbeidsmiljø. 3 Parter 2 Bransjer 1 Mål. Oppfølgningsundersøkelse: Kjøttindustrien. Årgang 11. Nr. 10 Jacobsen, K., Moland, L.E. & Pettersen, T HMS og IA: To sider av samme sak? En evaluering av prosjektet Sammen for et godt arbeidsmiljø 3 parter, 2 bransjer, 1 mål STAMI-rapport Nr 7 Årgang 11, 2010 Fafo-rapport 2010:26. Lau, B punktsundersøkelse: Kjøtt- og fjørfeindustrien. Sammen for et godt arbeidsmiljø, 3 parter - 2 bransjer - 1 mål. Serie: STAMI-rapport Nr. 24, Årgang 9. Lau, B punktsundersøkelse: Sykehjem. Sammen for et godt arbeidsmiljø, 3 parter - 2 bransjer - 1 mål. Serie: STAMI-rapport. Nr. 25, Årgang 9. Utaaker, E. & Hegdal, B Sammen for et godt arbeidsmiljø. Sluttrapport. Arbeidstilsynet. 402

399 D4: PROMOTION OF HEALTH, SAFETY AND WELLBEING AT WORK D4.1 Health-related behaviour and opinions on retirement Merja Perkiö-Mäkelä D4.2 Incentives for work environment improvements at manufacturing companies from a manager perspective Katarina Wijk D4.3 Health promotion in Denmark Fitting the task to the man or fitting the man to the task? Jakob Christiansen 403

400 HEALTH-RELATED BEHAVIOUR AND OPINIONS ON RETIREMENT Perkiö-Mäkelä, M 1 and Leino-Arjas, P 2 1 Finnish Institute of Occupational Health, Kuopio, Finland 2 Finnish Institute of Occupational Health, Helsinki, Finland The aim of this paper is to present Finnish e