SCHOOL OF COMPUTER STUDIES RESEARCH REPORT SERIES

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1 University of Leeds SCHOOL OF COMPUTER STUDIES RESEARCH REPORT SERIES Report Health and Safety: An Information Systems Design Issue of No Importance? by Tom G Gough February

2 Abstract Health and safety at work has been a concern over many years and in a variety of contexts. Particular concern has most recently been expressed (and reflected in legislation) about the health risks associated with the use of computer-based information systems. This concern has been heightened by an increase in the reported incidence of repetitive strain injuries (RSI) and other work-related upper limb disorders (WRULDS), and the anticipated increase in claims for compensation and the rising cost of challenging (or settling) such claims. However, it seems clear that the designers of computer-based information systems, whether in the healthcare field or other application domains, regard health and safety issues as of no importance. No attempt seems to be made to incorporate consideration of such issues into the information systems design process. There is no evidence that information systems designers see addressing health and safety as their responsibility. Taking the claims made above as its starting point this paper explores the likely consequences of regarding health and safety as an issue of no importance in information systems design. 1. Introduction The importance of health and safety at work has been a subject of concern for many years. In fact, Hippocrates, 'the father of medicine', reputedly expressed concern about lead toxicity in the mining industry in the fifth century BC! More recently, Watson (1984) suggested "One of our highest priorities in public health is the protection of millions of Americans during their working lives". This concern for health and safety in employment has been reflected in legislation directed at that concern and focussed on the priorities at the time. Most recently in the UK, European Directives on health and safety in the workplace were implemented on 1 January 1993 via new regulations and codes of practice issued under the Health and Safety at Work etc Act of 1974, see, for example, the Health and Safety Commission (1992) and Health and Safety Executive (1992). Health and safety issues in the office workplace may be grouped into four general categories: those associated with the workplace itself; those identified as related to fatigue; those that are stress related; and the range of risks associated with the use of workstations that incorporate VDUs. Many of these issues are interrelated and should be addressed together, though often research and the development of solutions has been addressed to one component out of many. The importance of a more holistic approach is discussed by Sharma (1999). Most attention has been paid to the problems perceived to be linked with the use of VDUs, largely because of the growth in VDU usage and the increase in the claimed incidence of repetitive strain injury (RSI) through similar usage. 2

3 2. Incidence of Health and Safety Problems There are problems in trying to determine the extent of the health and safety problems associated with the use of computer-based information systems, partly for the lack of agreement on the nature of the problems and their cause(s) and partly because of the lack of reliable data. However, the most widely quoted problem is that of RSI where the level of reported incidence has risen. A Reuters' press release of 11 February 1998 announced that British researchers (Greening and Lynn, 1998) had established that repetitive strain injury (RSI) is a real medical condition. Later in the same statement it was claimed that in Britain alone, RSI affects 200,000 people a year and that the disorder accounted for 60% of the 495,000 new cases of occupational illness reported in the USA in Another indicator of an increase in the incidence of RSI can be seen in the number of claims by employees for compensation for RSI and in the readiness of some employers (at least in the UK) to settle, preferably out of court. In the USA many cases have reached the courts. COT (1998) published a table of 32 major cases since Business Week (1995) suggested that RSI could become the nightmare for corporate America in the 1990's that asbestos was in the 1980's. According to the Bureau of Labor Statistics, North American businesses spent nearly $950 million in direct compensation costs for RSI in It is worth noting that the amounts awarded in compensation represent only part of the costs incurred by employers (and the public purse) as a consequence of the health problems perceived to be associated with the use of computer-based information systems. 3. Response of Information Systems Designers It is highly unlikely that information systems designers would disagree with the suggestion that one aim of information systems design should be to produce systems that do not put the health and safety of the users of such systems at risk. However, it is not clear that the design process is informed by this design objective. The impression given in the information systems literature is that health and safety is someone else's responsibility. If health and safety is discussed at all it is seen as peripheral to the information systems design process. This criticism of lack of attention to health and safety is valid across the range of information systems design methodologies. An initial review of a sample set of methodologies to support this assertion will be found in Gough (1991). A subsequent review in Gough (1995) showed little improvement despite the intervening implementation of the Directives in A further brief review in Gough (1998) showed little sign of any change in this situation despite the increasing concern about 3

4 the potential health and safety problems seen as being associated with the growth in the use of computer-based information systems. In terms of medical informatics, the focus is firmly on trying to ensure that computerbased information systems are used to deliver quality healthcare to patients. Unfortunately in pursuing the creation of the delivery mechanisms it is not clear whether any attention is being given to the 'health' of those who will be required to operate such systems. It would seem that for information systems designers, whatever the context, the health and safety of the users of the systems they design is an issue that they do not see themselves as required to address in the information systems design and development process. 4. The Possible Consequences Most organisations of any size employ computer systems in the conduct of their affairs and computers are becoming omnipresent in the workplace. The prediction made by Williams (1988) may well now understate the case. "Once a scientific tool and an aid to specialists in their work, the technology is becoming pervasive in factories, offices, educational institutions and homes. Before the end of the century, over half of the workers in industrial countries are expected to be working with visual display units or terminals as the central means of doing their jobs". (Williams, 1988) The growth in the use of computers at home is perhaps even more dramatic. "More people in Britain today choose to own a computer than a dog. A quarter of all households have a PC compared to one in five families who keep a pooch. Once in five homes even has two computers whilst one in 12 boasts three" (Harrison, 1998). If we continue to ignore the health and safety issues associated with computer use in the face of the evergrowing use of computers by an increasing percentage of the population at work and at home, we face the likelihood of an epidemic of computer-related health problems from RSI to visual problems to back pain to permanent disability. The evidence of both the health problems and the increasing numbers exposed to the risks of experiencing these problems is already available. Speculation about the possibilities is no longer necessary. Furthermore our ability to treat effectively those suffering from the health problems associated with computer use is open to question. In general, the members of the medical profession may have moved from a position of outright scepticism about computer-related health problems, in particular those labelled 'RSI', and may no longer discuss those who claim to be experiencing such problems as 'eggshell personalities'. 4

5 However, accurate diagnosis and effective treatment do not yet appear to be readily (or widely) available. 5. Remedial Action There seems to be no immediate prospect of a major change in attitude to the health and safety issues related to the design and use of computer-based information systems. There are perhaps two main reasons for this. The first is that health and safety appears, generally, to be seen as someone else's responsibility, despite the fact that legislation is often quite specific about where such responsibility lies, see, for example, for the UK, the Health and Safety Commission (1992). The second reason is that there is often a lack of understanding about the nature of the problems and uncertainty about the likely causes when problems occur, an area in which legislation may focus on the parts rather than the whole, inhibiting the acquisition of a clear picture of the totality, see, for example, again for the UK, Health and Safety Executive (1992). There are several courses of action that can be taken to try and address this unsatisfactory situation. Educating users and potential users about health and safety and those elements of work practice and in the environment that are likely to give rise to problems is likely be a cost effective first step. The results of a small scale experiment demonstrating the effectiveness of such an approach are reported in Gough and Sharma (1998). Employers, recognising the costs associated with computer-related health problems, could do more. Arksey (1998) sees encouraging signs here of employers being persuaded to provide safe conditions for their employees. However, as noted earlier, meeting the requirements of the legislation, a likely route for employers to take, may result in partial and hence ineffective solutions. What is required is a set of guidelines which seek to address health and safety issues holistically. Such a set of guidelines is being proposed by Sharma (1999). In the longer term those responsible for the education and training of information systems designers need to accept that health and safety is a design issue of first importance and then to incorporate addressing health and safety requirements into the mainstream of the information systems design process. More generally we need to increase awareness amongst the general public and the medical profession of the potential computer-related problems and their resolution, a task perhaps for Health Promotion. There may be a role also for Medical Informatics in the collection, collation and dissemination of the evidence, much of it widely scattered and not easily accessible. 5

6 6. Conclusions Despite the concerns expressed about the health risks associated with the use of computer-based information systems and their articulation in legislation, health and safety continues to be regarded by the information systems community as a design issue of no importance. The costs to individuals, employers and communities of the lack of attention to health and safety at the design stage will continue to rise unless there is a significant change in design practice. Short term remedial action is available to users of computer systems and their employers but the long term solution rests with the information systems designers. As yet the designers do not seem ready to accept their share of responsibility for the problems and their resolution. 7. References Arksey, H (1998), RSI and the Experts, UCL Press. Business Week (1995), The Asbestos Case of the 1990s?, 16 January 1995, McGraw- Hill. COT (1998), RSI Litigation Chart, Centre for Office Technology. Gough, TG (1991), Health and Safety Legislation - Threat or Opportunity: in Jackson, Mansell, Flood, Blackham and Probert (Editors), Systems Thinking in Europe, Plenum Press. Gough, TG (1995), Health and Safety Legislation - Implications for Job Design: in Robertson (Editor), Contempory Ergonomics 1995, Taylor and Francis. Gough TG (1998), Health and Safety as the Basis for Information Systems Design Requirements: in Hanson (Editor), Contemporary Ergonomics 1998, Taylor and Francis. Gough TG and Sharma RM (1998), Health and Safety in Information Technology - An International Educational Issue : in Banerjee, Hackney, Dhillon and Jain (Editors), Business Information Technology Management: Closing the International Divide, Har- Anand Publications. Greening J and Lynn B (1998), Vibration Sense in the Upper Limb in Patients with Repetitive Strain Injury and a Group of At-Risk Office Workers, International Archives of Occupational and Environmental Health, 71, pp

7 Harrison T (1998), It's PC in Our Time, 19 November 1998, Mirror Newspaper. Health and Safety Commission (1992), Management of Health and Safety at Work Regulations, HMSO. Health and Safety Executive (1992), Display Screen Equipment Regulations, HMSO. Sharma, RM (1999), Health and Safety Guidelines for Computerised Offices, to appear. Watson WC (1984), Public Health and the Workplace: in Cohen (Editor) Human Aspects in Office Automation, Elsevier. Williams TA (1988), Computers, Work and Health: A Socio-Technical Approach, Taylor and Francis. 7