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Evidence-based practice for the prevention of work-related MSDs

Musculoskeletal Disorders Symposium 2017

Robin Burgess-Limerick

Presented by: Professor Robin Burgess-Limerick (UQ)

Run time: 43:27

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Keynote 3: Evidence-based practice for the prevention of work-related MSDs

Presented by: Professor Robin Burgess-Limerick (UQ)

[Start of transcript]

Madonna King:

Now ladies and gentlemen, our third keynote presenter is Professor Robin Burgess-Limerick from the University of Queensland.

Thank you. A professor of human factors in the Minerals Industry Safety and Health Centre, he's had more than 25 years' experience in researching the prevention of work-related MSDs, and he's led the team which developed and evaluated the PErforM program for four years to 2004.

Today he's going to provide a whirlwind tour through the evidence basis for practice in the area of occupational MSDs. It's sub-titled A Personal Journey. He'll illustrate the issues through examples drawn from his experience and his research.

Remember if you have a question you can pop it into the activity section in Zeetings, and I'll endeavour to pick it up. If you see a question you would like answered, you can like it by pressing the heart, and that will then boost it to the top of the page.

Please join me now in welcoming Professor Robin Burgess-Limerick.


Professor Robin Burgess-Limerick:

Right. Am I mic'd? I am. Great. Thank you very much. This is a very exciting time. I don't think I've presented to quite so many people in one place at one time. It makes a change from the eight I had in my last presentation, which is great. Thank you very much.

So yes, as Madonna said it will be a whirlwind tour through 25 years. Let's get started.

Before we look at prevention straight away, let's review first what we know about the causal relationships between work and some of these injuries. So these images represent the diversity of the tasks which people perform at work, and all of those have some degree of risk of musculoskeletal injury. But what is it about those tasks which really contributes to that risk? If we can answer that question, then we've got a start on the bigger question of how do we prevent them.

So let's look at a couple more in a little more detail. So I'm hoping we could probably all agree that there's some injury risks associated with doing that task, okay? And this is real. I didn't mock this up. This is real. An interesting thing is I brought this back to Brisbane and showed it to the mining company, and they said, 'We don't do that do we?' So, yes.

Anyway, what is the issue?


I think we can all agree it's got something to do with exertion. Okay. We got it. So it's something to do with the maximum exertion involved.

Okay. What about this guy? Now this is a task that definitely was associated with injury risks, that's why the video was taken. So what's going on? Well normally he's lifting those cages at the back there. They don't weigh particularly much and they usually come up pretty easily, but occasionally they get stuck and this is the consequence. So what's causing the injury risk there? Again we've got exertion, so using maximum force, but somebody said it. Okay. So now we've got some pretty extreme posture. Why have we got a pretty extreme posture? Well it's where the hands have to be to perform the task. So a lot of posture is dictated by one of two things. Where have your hands got to be to do the task, or sometimes where have your eyes got to be to see what you're doing.

Okay. Here's another one.

Now it's not particularly extreme exertion nor particularly extreme postures. We do have some repeated similar movements, and what we can't see from the video which really determines whether this is a big problem or not is the exposure, how long is this done for and how often is this done. But it's potential. Call it hazardous. It has potential to do harm. But it's a function not just now of exertion and posture, but also of repetition and exposure.

What about this guy? What do you reckon hurts the most?

Neck. Okay. If I had to put my money on it, and I've not done it – Gary says we ought to try and do the tasks but I draw the line at this one. I reckon it's his neck is going to hurt the most. Why?

Yep. So you've got really quite a large mass in your head, and in that sort of posture it's acting at the moment arms quite large from the centre of gravity of the head to the axis of rotation in the neck, and the muscles which are holding it in place are really quite small, and if you like they're not designed – ecologically speaking we don't spend much time in that sort of posture. But what's the other key thing there is that posture has to be maintained statically so that he can see what he's doing. So that sort of a situation is really rapidly fatiguing, and if we think there's a link between fatigue and subsequent injury, then that has injury risk.

So if you have some doubts about that and you want to try it out experientially, try it in bed tonight. Take your pillow away and try holding your neck up. See how long you last.

Okay. This was a bit of footage that came across. We were trialling the original version of the Mantra tool and we went up to the university library and just happened to come across this guy who'd been doing this job, re-shelving, for a very long time. Now we don't do it anymore. We get students. We don't have full-time employees to do this sort of thing anymore, but at the time that's what he did. So do you notice anything a bit odd about the first part of the clip?

Why would someone hold a book between those two fingers, not your thumb and forefinger? Well the answer is in the second part of the clip. After many years of performing that task with a really wide grip, so a really wide awkward posture you might say in the hand, and providing really quite a large tangential force to keep those books in the middle in place, and then doing it repetitively and over a long period of time there's an extreme cumulative injury, so to the point where we asked him of course – 'No, I can't grip a book between thumb and finger anymore'.

So that's the extreme to me of putting it all together. We've got forceful exertions. Now remember it's not absolute force, because the absolute force is not high. It's relative to the capabilities of the tissues involved and the smaller muscles of the hand. So exertion, awkward posture, repetition, long duration. Combine all those things together and yeah, you've got really quite a high risk of injury.

But there's a few other things aren't there? So we could think about the heat in this situation. And this is on the tapping floor in the lead smelter at Mount Isa. I think it's one of the most uncomfortable looking jobs I've ever seen, and obviously the heat is a big part of that and contributes to the overall fatigue and issues with the task.

Okay. What about this task?

I'll just let it play so you can get a feeling for what's going on.

Okay. Now we've got a combination of things. The small muscles of the hand remember and the wrist. So we've got forceful exertion, awkward posture, repetition, long duration, and the thing that you can't see which you might infer, it's cold. Okay. So this video came from Margaret Cook's PhD work where she was looking at the instance of carpal tunnel syndrome in the meat industry, and if I recall the results correctly this was one of the highest risk tasks that Margaret found.

So heat and cold. So there's more isn't there?

So a dozer on a surface coal mine. So this was footage taken by … in Central Queensland a year or so ago. Can't really get the impression from this vantage point, but that operator is being exposed to whole body vibration which exceeds any threshold that you care to mention.

If we take a look inside the cab you can get a better appreciation of the situation, and of course now we're combining the vibration levels with awkward posture of the neck. So this is another situation where again it depends on exposure, but these are 12-hour shifts. If this person does this eight to 10 hours a day over the length of a career, then the probability of injury is extremely high.

Incidentally we've developed a free IOS application for measuring vibration of this type. So if you go to the app store and search for WBV you'll find our free app. Buy yourself a $250 iPod and you can measure your own whole body vibration and do it as much as you like.

So of course that's one sort of vibration. The other sort of vibration is peripheral vibration, exposed to power tools in many industries. Again it's about exposure, but high amplitude at the right frequencies, long duration, you can permanently damage your nerves and blood vessels.

So that's really anecdotal of course, isn't it? I've just sort of run it through. You probably believe me. But let's have a look at the literature quickly. The seminal study is 20 years old now by NIOSH, reviewed 600 studies that existed at the time, the strong evidence. Now I'm going to run through these slides very quickly, because there is a slide pack I've prepared and it's got all these slides and more. So I won't read out all these words. Just to let you know that I'm not making it up.

And I suspect that everybody in this room accepts this, but I did have a conversation last year with the Chief Medical Officer of a multinational mining company who shall remain unnamed, who said, 'Yeah, I'm not really convinced musculoskeletal disorders are work related'. I said, 'Oh. Okay. Right'. It caused me to go back and look at the literature again just to make sure I got it right.

Anyway, there was another report a few years later. Now interestingly and importantly this one picked out the other side of the equation, which is the psychosocial aspects of work, and we heard mention of those this morning. So stress interacts with the physical aspects. Exactly how, we may not know for sure, but it certainly does.

Those are all cross-sectional studies. More recently we're starting to see longitudinal epidemiological investigations. It's the same results.

Now Anita particularly asked me to cover this topic. I hope I don't really need to. But it has been common in the past to say, well if we could just train people to do things differently, they wouldn't get injured. And the classic is if we could just train people to lift safely. So does it work? Well, I love the picture over on the left there. It was from a brochure I picked up at a conference once. I mean there's this lovely enthusiastic new graduate showing this beautiful full squat posture, and the worker going – you can just see the speech bubble can't you? 'You've got to be kidding'. And the manager at the back going, 'This is a cheap solution isn't it?'

Does it work? What's the evidence? Well, no. 'No. No. No. No. No. Don't do it please'. There is no evidence. In fact there is very good evidence that it doesn't work. And it's not new. The otherwise very influential Work Practices Guide for Manual Lifting from NIOSH, 1981, it summarises the research that was done in the 1970s which showed why a full squat was not a good idea. And it also says in a different part of the report most controlled studies of training have shown it to be ineffective in reducing accidents and injuries. Did I say this is 1981, 36 years ago? There has been no evidence since then to change that conclusion.

So this is where the personal bit starts. About 1989 or so literature was pretty much in the same state and I was casting around for a PhD topic. What could I do for my PhD? And I liked the French 19th Century painter Jules Bastien-Lepage. I decided that I'd record what people do. So in his case it was a reaction against the formal paintings of the aristocracy. So he got out in the countryside and painted what people actually did. In my case I brought them into a laboratory and kitted them out in reflective markers and EMG electrodes and it wasn't quite as pretty a picture, so I thought I'd show you his.

But the thing was I started off my PhD thinking that if I could work out what people normally did I could then work out how to change it and come up with a better way of training people. Three years later I'd sort of realised I was barking up the wrong tree. So what I discovered was that people adopt a semi-squat posture to lift low lying objects, and they do that for a really good reason. The inter-joint coordination pattern which they adopt is highly functional, and so if you're tempting to mess with that, well that's just foolish and really it's bound to fail. It also became clear from the literature that was accumulating that training really didn't work.

So it's not just me saying it. I'm sure the Detroit AL people who did a three-year project with US postal workers involving thousands of workers – I'm sure they were really disappointed to have to say it didn't work. No long-term benefits. And the interesting thing about that study is that most studies evaluating such things have really quite low statistical power, and if you get non-significant results you really can't say anything. This study on the other hand had a large sample, such high statistical power, that the non-significant finding is actually quite meaningful.

So there have been lots of reviews. Roger Haslam reviewed for the UK HSC and concluded that no, there's no training of transfer to practice. So there's a couple more there. It's really quite remarkable, because it's very hard to demonstrate no effect. Usually you just sort of end up with well, we can't say one way or another. But in this case for this question, 'Is lifting training effective?' We can say no. So the jury is in.

So now we get to the topic. If not training, what does work?

So on one slide this is what we know. If you want to reduce musculoskeletal injuries, the thing to do is to identify the hazardous task, that is the task that has potential to do harm, and eliminate them. If you can do that you've got a very good chance of being successful at reducing injury risks. Unfortunately the reality is that many of the tasks can't be eliminated. In that case the job is to redesign them to remove this exposure to those tasks' characteristics that we spoke about earlier on. And then the method of doing that, we've got to make sure that the people involved participate throughout that process, through the process of identifying the hazardous tasks, the process of redesign and the process of implementation. So we call that participatory ergonomics.

And what I haven't got up on the slide but it's sort of really almost crucial, you've got to make sure that that redesign also improves productivity, because if it doesn't improve productivity it's going to be a hard thing to sell. It may happen, but the likelihood is it's not going to happen quickly or easily. So you're looking for solutions that are more productive as well.

So let's have a look at this participatory ergonomics thing in a bit more detail. So I was really impressed I could find this brochure from 1982 in my files. The Ergonomics Society, as it was then, organised a week of activities in Queensland, Ergo Week. Amazing. Good sponsor there. Workplace Health and Safety Queensland was involved at the time. One of the sessions was by John Wilson who at that time was at the University of Nottingham, and he presented a case study describing the redesign of a crane workstation where the people, the crane operators, were the ones who made the decisions. And to me it was like oh, lightbulb moment, because everything up until then – the dominant paradigm was really the expert ergonomist model. So you might consult people, ask them questions, but the person making the – it was the expert who made the recommendations about what was going to happen. So participatory ergonomics as we heard again about this morning, it means putting as much control as possible in the hands of those who do the work.

So the benefits are held out to be more effective redesigns, getting a better solution, and more likelihood that they're going to be implemented. After all, if the people who are doing the work came up with it, they're much less likely to resist, more likely for it to happen, and there's also purported benefits in terms of culture and job satisfaction.

The thing was, there wasn't a lot of evidence at that time to justify those claims, and so by the end of that century I was working with Leon Straker and Claire Pollock from Curtin University of Technology, and we conducted a randomised controlled trial of a participatory intervention. The intervention went by the acronym PErforM which some of you may have heard of. It was designed to provide short-term consultancy type assistance to small businesses. So there were 48 single site businesses involved, and nine months after the program was delivered we found a decrease in manual task risks as assessed by Workplace Health and Safety inspectors.

So we gathered some evidence and we were pretty pleased about that. In some ways it's really gratifying to see that program still living on 17 years later.

But at that time the mining industry was the biggest game in town, and emboldened by our success with small businesses we conducted some case studies using the same program, first with surface coal mines and later with underground mines. So we were successful in demonstrating that, that the same techniques could be used in large organisations, very different organisations, to generate control measures. And the handbook that we published at the time has been well cited by the industry regulators there.

As I said we worked some more with underground mines, and at the end of that process we'd really learned a few things about transferring that information to the larger organisations. Now large organisations are not qualitatively different from small organisations in the sense that management commitment is absolutely critical, it's just in large organisations it's a bit more difficult because they're so big. So it's not just that management have to be committed, they have to be seen to be committed, and sometimes that's an issue, particularly if you've got people who never see the boss.

So the other thing we determined was that the tool we'd provided in that PErforM program, while we called it a risk assessment we realised about this point it wasn't actually, it only covered the risk analysis part of risk assessment. To do risk assessment you have to do evaluation as well, and that was really important in the large organisations. They needed that evaluation to feed it into the safety management systems.

We unfortunately discovered the hard way that the role of the site champion is critical. So if a site champion moves, we discovered you can lose a whole program. It just suddenly ceases to exist, and six months later everyone's forgotten it was implemented. So you need to have some redundancy plans in place.

Middle management is important, and supervisors. If you don't get their buy in, it doesn't matter how much the boss thinks it's a good idea. Then the other thing we started to see was the communication within large organisations is critical. How do you communicate what you're doing between crews, across the organisation, and the documentation when you get it right, but perhaps even more important when things don't go right. Because otherwise you know what's going to happen? In a year or two's time somebody else is going to look at the same task and try the same thing again, and also fail. Now what a waste of resources.

About that time I spent six months in Pittsburgh at NIOSH there. Now we were working with the largest manufacturer of aggregates, and they had 300 quarries. So the model shifted from direct intervention to a train the trainer model, and our research questions shifted more towards what sort of tools and techniques can we provide to help them roll out that model. So we worked on different ways of evaluating risk and communicating the outcomes. So here's one example. The example actually comes from our work in Queensland, but you can see this guy pulling the magnet across. Yeah, not a good idea. And the solution wasn't hard to find. We just had to look down the road at another site, and you just put a winch on it. No problem.

So the solution generation wasn't the issue. The trick is now how do we convince management to spend that sort of money.

So then that's where the communication comes in. How do we capture the risk in a way that it can be understood and the potential benefit of putting a control measure in place?

Okay. So back in Australia, Gary, Dennis and I started working with Queensland Rail, and I'm just going to show you this example. I think it's Gary's favourite from the time. This is a diabolical task. The grinder weighs 68 kilograms and the guy has got a – you can't really tell, but he's holding that in place while he moves the grinding wheel around. He's got to move it around on the rail and it has to be taken to the track in the heat, under stress, because we've got to fix this rail before the next train comes. The task also requires a lot of skill, so only the most experienced operators did it. You can see the scenario building up where it's a high risk situation.

So the analysis and evaluation is pretty clear. This is a pretty extreme injury risk. The solution wasn't so clear. Gary can give you the extended version of the story, but it involved many workshops with the track maintenance workers and other QR staff, and importantly the manufacturers of the equipment. So many months later there were two manufacturers who produced prototypes and then they were given feedback and critique by the operators, and eventually one of them came back with an acceptable solution. So the outrigger there holds the mass of the grinder. You can see the wheel that he's turning there with his hand is a remote way of turning the grinding head. So the awkward postures are removed, the forceful exertions. It's clear the risk has been reduced. Also put a more powerful motor in it to improve productivity.

And my favourite part of the story is the last bit. If you go to the ROBEL – it's a German manufacturer – if you go to the ROBEL website now, you can see a photo of the rail head profile grinding machine and order it from anywhere in the world. So to me that just shows it started with some people in North Queensland saying, 'This task really is a problem. We've got to fix it'.

So one more example. So this one was facilitated by Sara Pazell from Viva Health at Work. These guys are laying a bituminous tape on a new section of roadway. So one worker walking backwards and a flexed posture. Not really extreme forceful postures, but you can see the sort of problems we're talking about. The analysis. Now note there one bit of roadway that was underway at the time required 64 kilometres of this tape. Okay, so that's the real kicker there. If we did that once, yeah, not such a problem. If you've got to do it for 64 kilometres, we've got an issue.

So again Sara facilitated workshops with the employees, and there was several iterations and the engineering was done by Cockhams and Carl Doyle. But there's the solution. Really quite neat.

Removes one person from doing the task. It's faster, more productive. And you know what? In terms of total worker health, I'm going to say that's exercise. So as long as we don't do that all day every day, I'm going to say that's likely to send somebody home with a bit more exercise than they might have had otherwise.

So I think to me that's the pinnacle of achievement. We've devised some healthy work.

So the evidence. Participatory approaches were often but not always successful. This I think from Barbara Silverstein is the one that captures the evidence in this area, because it is a little mixed. If you look at individual studies, some show benefits, some don't. So often but not always successful. Now if you average that out as Donald Cole did, you get a small positive effect. But I don't think that really captures it. I think Silverstein's conclusion is closer to the mark.

So there's a couple more reviews from Riverless, one there and one on the top there. And on the bottom there the most recent paper I came across. It was a multi-site – it was an aluminium refinery in the US or aluminium smelters and refineries, manufacturing in a way, multi-site. They really found they got some effective reductions in risk. So in terms of putting it all together, that's the way I'd see it.

But why Barbara Silverstein's statement? Why often but not always? And this is where the research, the current research questions are I think. Why have some organisations like Rio Tinto had really great success? And we'll show you some of their work in a moment. Others, including some that we've worked at, not so much. So there's something going on. Now some of it might be down to the differences in the processes employed or the tools used, and if you look at the literature don't just read the abstract, read the detail of the method. What did they actually do? So a participatory ergonomics program means different things to different people, and if you read some of the studies, they're really pretty superficial interventions and the opportunity for meaningful work or engagement wasn't really very high. So they might have called it participatory ergonomics, but it wasn't.

Or it could be the intervention lacked some effective ways of assessing risk or communicating results, or it was clear that the workplaces they went into didn't really have the management commitment quite, and that really seemed to be quite common. You read the research. They say, 'Yeah, we did all this, all this, but we couldn't finish it because X, Y and Z'. And you say, 'Well why couldn't you finish it? The only reason for that is because management didn't want you there'.

So there's more to it than just processes and tools. This is where Sara Pazell's PhD is going at the moment. It's looking at what is it about different organisations that means they can be successful. And so one of the sites is Weipa, Rio Tinto Weipa. They've had great success. You can see down in the right hand corner there Christian Wakeling and Rebecca Winks accepting their award from the Queensland Mining Safety and Health Conference in 2015.

But what is it that they're doing which is giving them such great success? Well if we look at what they do, there's 1,200 workers on site, and Christian the physiotherapist there has trained 20 of them to be manual task assessors. And their job is to facilitate that process of identifying hazardous tasks, eliminating if they can, redesigning if they can't. The site has a target of 30 tasks a year. Now that target is set by senior management. It's included in the middle management's KPIs. So it's driven through their normal performance management process. To me, that's a really big part of the success. So this is a valued endeavour.

They are really good at communicating what they're doing. They communicate their successes and they celebrate their successes. So the culture is one of encouraging innovation. So to me that's a really big part of the process.

Now Sara is continuing that research, and if you have experience, particularly if you have experience with implementing such programs, Sara would be delighted to talk to you. She's got a page out on the ErgoAnalyst stand to sign up, or if you drop her an email she'd love to talk to you.

So to conclude, based on what we know so far, and as I said it is an area of active research interest, particularly why does it work sometimes and not others. These are the ingredients. This is what you need to have I believe for success in implementing such a program. You've got to have management commitment. If you haven't got that, you've got to focus on that first. If you can't convince senior management this is important, then really the rest of it isn't going to help. So you've got to start with that part, and from senior management commitment comes the resources required to execute the program.

You need a participatory process. There's obviously various different ways of going about that, but the more the process can empower the people who do the work – they need some knowledge. We'll come to that in a moment. But they also need some power. And we've seen that if you've got a sceptical workforce – we're not used to doing this thing. Nothing will ever change – give them a budget. Say, 'Well there you go. You've got a budget. It's pre-allocated. You decide how you're going to spend it'. That's a really good way of getting people engaged and believing actually something might happen. So if you've got that sort of issue, that's one way of going about it.

Then you need some tools for doing the risk analysis evaluation and communication, and the analysis and evaluation has to happen not just before and after, but during. So when you're coming up with potential solutions, it's time to take a step and say, 'Right, if we were to do that, what would it do to the overall risk?' Because what happens of course is that the first things that people come up with are not going to be the most effective. You need to really drive people up the hierarchy and start thinking about elimination. So if the change they want to do is let's go from a straight shovel to a bent shovel, that's okay. Let's capture that. Let's do an analysis of that. What sort of difference is that going to make? Very little. Alright. Let's keep thinking. What else could we do?

And you need some sort of training for that. You can't expect people to be able to fully participate without some training, and basically the sort of things I started off this presentation with. What are the issues which contribute to that risk of injury? But not using videos like those ones. Use videos from their workplace. So using video footage specific to the task or to the workplace is another really good way of engaging people and saying, 'This is real. This is what we're going to do. We're going to fix some of these things'.

The site champions we talked about. That's an absolutely critical role. They need a bit more training. Their training might need to extend to – how do you facilitate a workshop? What are the rules of brainstorming for a start, but how do you facilitate a workshop and importantly what happens in between those steps. So we have the risk identification step. What has to happen before now you're ready to look at redesigning tools? And the step in there is research. What needs to happen? Well we've come up with some options. We need to talk about implementation. What has to go in there? What does that person need to do to drive the process forward?

But to reiterate, management commitment is the most important thing. And often we think at senior management level and say right, it's really important to get senior management on board. It's got to come all the way down. And we've seen that a few times, that middle management may be resistant or supervisors may be resistant because they've got their daily KPIs to meet and they've got the daily production pressures. So the trick is somehow to get those people on board and for them to stay on board, because circumstances change, environments change, production pressures suddenly arise. How do you keep the program going in the face of those pressures?

So I didn't say it was easy, but if you can get all those ingredients in place then the evidence suggests that you've got a pretty good chance of successfully reducing injuries.

So thanks.


Madonna King:

Thank you. Now we've got six or seven minutes for questions, so let's try and get through as many as we can. Remember you can lodge them on Zeetings. Would anyone like to start by raising their hand and we do it in the old fashioned way?

Okay. I'll start the first one and then I hope to see a flood of them.

Audience member:

You showed us all sorts of examples, and everyone inhaled as you showed them. But what proportion of the at-risk working population do you think actually understand the risks they take?

Professor Robin Burgess-Limerick:

Well I think we saw some slides this morning that spoke to that question about the perceived risk, and I think we are actually not very good at accurate perception of risk in many of our activities. We perceive risk is lower when we feel like we have control. So your male who decides they're going to dive off a pier into shallow water does so not because they don't perceive it as a risk of hitting their head, but because they feel like they're in control.

So we feel like we're in control when we're driving a car, so we perceive lower risk. Whereas actual fact driving a car on an undivided highway is probably the highest risk thing that we do. So the answer I think to the question is no, not very well.

Madonna King:

Okay. Is this a question that we have here?


Audience member:

What is management commitment? Management commitment is the employee perception that managers actually care about our safety, noted by management behaviour.

Professor Robin Burgess-Limerick:

Yeah. So I'm going to rephrase the question as how do workers know whether management are committed? They might be up in their office and they might be really, really committed, but does the person on the shop floor know that? So no, it's only by actions that commitment can be demonstrated, and particularly – I mean the stuff in the literature about what sort of organisations these processes are most likely to work, and it's where there's been a good history of labour relations. So if you've got an antagonistic history, then you've got a much harder road to hoe. But it's about demonstrating commitment, and one way to do that is to say to a work group, 'You've got a pre-approved budget. You decide how you're going to spend it to improve your work'. That's actions.

Madonna King:

Alright. Our next question on Zeetings is, 'What are the essential ingredients of successful participation?'

Professor Robin Burgess-Limerick:

Some knowledge. Some willingness to be involved. If you're starting a new program and you believe there's going to be some issues about willingness to participate, then you'd probably start with a pilot program, and you don't choose the most difficult part of the place to start with, you start with the place where you think it's most likely to be received well. So you need some sort of engagement to get that participation happening.

Madonna King:

You say for success to happen there needs to be management commitment, a participation program, risk analysis, evaluation and training, and management is the most important element of that. Where in your experience does it usually fall down? In which one of those?

Professor Robin Burgess-Limerick:

In the initial studies, some of the initial research we did working with nursing homes and accommodation for the aged, I recall being a little bit disappointed because it became apparent that some of the workplaces had put their hand up because yeah, that will look good on accreditation. There really wasn't the genuine commitment to making changes to improve the safety of the workplace. So I think that's a problem. If you've got people who are, 'Yeah, yeah, we're going to be involved. We're going to be involved. It's going to look great,' but not actually want to change things. The management have to realise that there are resource implications. Now the aim is to make things more productive, but you've still got to change things even if that's not going to be resolved.

Madonna King:

Our first question from the back there. Thank you. And then we've got another one up here in the second row.

Audience member:

Robin, Deidre Rutherford. Just talking about management commitment, trying to get their buy-in when they have this incredible preconception about the value in lifting technique, their constant focus on the worker as opposed to organisational work design, what are a couple of the tips that really, really get them to get that shift and buy in?

Professor Robin Burgess-Limerick:

There are some people who just don't get it. In some ways it's a whole blame the victim type mentality, that it's not just restricted to manual task injury risks. So I don't know that I have a great answer. I just keep beating the stick over people's heads when they talk about lifting training. Don't waste your money. Spend it on something more worthwhile. But I don't have a magic wand. I wish I could change the perception of the world, but it's not that easy.

Audience member:

Hi. Lori Deakin here again. So I'm just interested in the participatory ergonomics experience, and it worked very favourably recently with our work in theatre, in operating theatre, but it took about 6 months I suppose. It was a change management process. It wasn't just a 'you're not moving patients to standard' change, it was what's difficult about the standard and how you are moving your patients in the hospital, and going through that eliminate etcetera, etcetera. So it was a big change management process, and that's quite a long successful skill, and many people need to have that skill, not just the facilitator. So I'm just acknowledging – it's more of a comment than anything else. It's a big job.

Professor Robin Burgess-Limerick:

Yeah. Did I say it takes time? Probably not. It doesn't happen overnight. I mean these things take time, and changing culture and expectations and – especially if you've got a workplace which isn't used to having changes driven by people who do the work, it's not going to change overnight.

The other thing about patient handling, particularly difficult one. That's the only place I'll allow where there may be a role for some technique training, handling people. The package is not easy to change.

Madonna King:

Our next question on Zeetings. 'Site champions need to have what kind of background?'

Professor Robin Burgess-Limerick:

No particular background. More important is their attitude. We've trained – people like Christian Wakeling who's a physiotherapist, that's a great background, but it's not essential. It's more important that they have a commitment to wanting to change things and understanding that we can change things, and working with people.

So we've probably had the least success with some of the track workers at QR who had been in theory trained to be site champions for this process. Not all of them were able to do it. But you don't need to have any particular qualifications. No.

Madonna King:

And the name of the app that you mentioned? Can you give us that again?

Professor Robin Burgess-Limerick:

For vibration? WBV.

Madonna King:


Professor Robin Burgess-Limerick:


Madonna King:


Professor Robin Burgess-Limerick:

Whole body vibration.

Madonna King:

Whole body vibration. Ladies and gentlemen, please put your hands together for Professor Burgess-Limerick.


Now as we did previously, it would be great if you could provide some private feedback on what you've just heard now. If you've forgotten the link, it's, and that is the first question. How would you rate Professor Robin Burgess-Limerick's presentation today?

If I could just ask you to wait until we just finish this. Thank you.

How would you rate Professor Robin Burgess-Limerick's presentation today?

Our second question, will you change your current approach to managing MSDs in the workplace based on what you have learned?

Thank you.

And our final one, your takeaway message, that word or sentence or phrase that you take out of Professor Burgess-Limerick's presentation. Just while you're answering that, can I let you know that we move straight back into our streams now. They're on your program, but in P9 it's Jay Manne and Dr Rabiul Alam will present NOJA Power's journey with redesigning their production line. That's P9. P10 is Stephen Hehir presenting the application of good work design and human factors. That's on Australia Post's parcel sorting system. And P11, Olivia Yu will be presenting on the return on investment for preventing MSDs.

Thank you.

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