Occupational Injury and Illness Disparities Research in the Healthcare Work Environment: Opportunities and Obstacles

1. Occupational Injury and Illness Disparities Research in the Healthcare Work Environment: Opportunities and Obstacles Craig Slatin, Sc.D. Jamie Tessler, M.P.H. Michael O’Sullivan, Dr.P.H. Laura Punnett, Sc.D. The PHASE in Healthcare Project Univ. of Massachusetts Lowell This project is supported by a grant from the National Institute of Occupational Safety and Health Grant #R01-OH07381-04, “Health Disparities Among Healthcare Workers.”

2. “PHASE” Project Promoting Healthy and Safe Employment in Healthcare. Key Question: To what extent is the socio-economic gradient in health explained by factors in the work environment?

3. The Setting: Community Hospitals and Nursing Homes • Healthcare: a major sector of the U.S. economy • 2003 expenditures = $1.5 trillion • Diverse workforce • Multiple occupations • High rates of acute injuries, MSDs and other occupational illnesses

4. Multidisciplinary Qualitative Methods Quantitative Methods Multiple Domains Macro level: Industry and Facility Occupational Exposures Health Endpoints Social and Economic Outcomes The Nature of Health Disparities Research

5. Unique Aspects of the Healthcare Industry • Hospitals are among the most complex organizations • Contain both “clinical” and “hotel” functions • Conflicting accountability structures • Industry recently restructured by neoliberal economic policies

6. Challenges to Research • Emphasis on patient safety versus employee health and safety • Unclear definition: “Who is a healthcare worker?” • Working conditions: overtime,  turnover, downsizing, etc. • Heavy demands on workforce outside of the facility (83% ♀, second job, work/family balance) • 41% part-time workers (esp. nurses)

7. Challenges (cont’d.) • Few unionized facilities in study region • Negotiations with employers and access to employees • Limited size and scope of H&S infrastructure • Distrust of academic research • Limited diversity and affirmative action programs

8. Research Impact on Healthcare Facility • Community hospitals not accustomed to demands of research • Interruption of patient care routines • Managers already wearing multiple hats

9. Sustaining Facility Participation • Management concerns re: • discovery of safety hazards • employee discontent • Regional unionization drives • Negative publicity • Disparity: local facility versus parent corporation • Presence of healthcare unions on PHASE advisory board • Impact of economic restructuring RESULT: 3 HC org’s lost by 3rd year.

10. Quality of Available Data • Uneven use of computerized databases across facilities • Race/ethnicity/native language data absent or inaccurate • EEOC data could not be used to classify SES • Data on Staffing difficult to obtain; decentralized procedures by dept.

11. Injury/Illness Data • OSHA logs lacked Department info • Workers’ Comp data lacked job title • Heavy underreporting suspected in HC industry • PHASE qualitative results show: • Injuries considered part of job, not reported • Compensation too cumbersome, workers don’t bother • Return to Work programs are problematic • Workers can’t afford ($) not to work

12. Strategy – Select facilities based on prior connections and loyalties and utilize those relationships effectively. Results – Mixed. Top level management: effective Staff level: loyalties (e.g. alumni) not activated /utilized Barrier #1:Facility Selection

13. Strategy – One-on-one conversations with employees Results – Good; reached workers via job fairs, dept. meetings, exposure assessment team activities Barrier #2: Employee Recruitment

14. Strategy – Identify what managers value most: Prestige Routine Productivity See if research can support them Results – Mixed: PHASE may not have listened enough Proposal already defined Moving fast to compensate for IRB delays Barrier #3Management Buy-In

15. Summary • Conflicting needs • Employees • Managers • Patients/residents • Researchers • Healthcare org’s are trying to deliver quality patient care and keep the organization economically viable • Researchers want to study health disparities Summary: More obstacles than opportunities