Improving construction site safety through leader-based verbal safety communication.

BACKGROUND: The construction industry is one of the most injury-prone industries, in which production is usually prioritized over safety in daily on-site communication. Workers have an informal and oral culture of risk, in which safety is rarely openly expressed. This paper tests the effect of increasing leader-based on-site verbal safety communication on the level of safety and safety climate at construction sites. METHOD: A pre-post intervention-control design with five construction work gangs is carried out. Foremen in two intervention groups are coached and given bi-weekly feedback about their daily verbal safety communications with their workers. Foremen-worker verbal safety exchanges (experience sampling method, n=1,693 interviews), construction site safety level (correct vs. incorrect, n=22,077 single observations), and safety climate (seven dimensions, n=105 questionnaires) are measured over a period of up to 42 weeks. RESULTS: Baseline measurements in the two intervention and three control groups reveal that foremen speak with their workers several times a day. Workers perceive safety as part of their verbal communication with their foremen in only 6-16% of exchanges, and the levels of safety at the sites range from 70-87% (correct observations). Measurements from baseline to follow-up in the two intervention groups reveal that safety communication between foremen and workers increases significantly in one of the groups (factor 7.1 increase), and a significant yet smaller increase is found when the two intervention groups are combined (factor 4.6). Significant increases in the level of safety are seen in both intervention groups (7% and 12% increases, respectively), particularly in regards to 'access ways' and 'railings and coverings' (39% and 84% increases, respectively). Increases in safety climate are seen in only one of the intervention groups with respect to their 'attention to safety.' No significant trend changes are seen in the three control groups on any of the three measures. CONCLUSIONS: Coaching construction site foremen to include safety in their daily verbal exchanges with workers has a significantly positive and lasting effect on the level of safety, which is a proximal estimate for work-related accidents. It is recommended that future studies include coaching and feedback at all organizational levels and for all involved parties in the construction process. Building client regulations could assign the task of coaching to the client appointed safety coordinators or a manager/supervisor, and studies should measure longitudinal effects of coaching by following foremen and their work gangs from site to site.

Protocol for a mixed-methods study on leader-based interventions in construction contractors' safety commitments.

BACKGROUND: Owing to high injury rates, safety interventions are needed in the construction industry. Evidence-based interventions tailored to this industry are, however, scarce. Leader-based safety interventions have proven more effective than worker-based interventions in other industries. OBJECTIVE: To test a leader-based safety intervention for construction sites. The intervention consists of encouraging safety coordinators to provide feedback on work safety to the client and line management. The intention is to increase communication and interactions regarding safety within the line management and between the client and the senior management. It is hypothesised that this, in turn, will lead to increased communication and interaction about safety between management and coworkers as well as an increased on-site safety level. SETTING: A group-randomised double-blinded case study of six Danish construction sites (three intervention sites and three control sites). The recruitment of the construction sites is performed continuously from January 2010 to June 2010. The investigation of each site lasts 20 continuous weeks. METHODS: Confirmatory statistical analysis is used to test if the safety level increased, and if the probability of safety communications between management and coworkers increases as a consequence of the intervention. The data collection will be blinded. Qualitative methods are used to evaluate if communication and interactions about safety at all managerial levels, including the client, increase. OUTCOME MEASURES: (1) The proportion of safety-related communications out of all studied communications between management and coworkers. (2) The safety level index of the construction sites.

Disability retirement among workers involved in large construction projects.

BACKGROUND: The aim of this study was to evaluate the incidence of disability pension among workers engaged in the construction of the Øresund Link or the Copenhagen Metro, representing high levels of safety management. METHODS: The study subjects (n = 1,808) were followed for disability retirement. Age standardized incidence ratios (SIRs) were calculated and compared with SIRs of disability pension established in a previous study of workers engaged in the construction of the Great Belt Link (N = 5,882), representing a low level of safety management. RESULTS: Compared with all economically active men, the age SIR of disability retirement was 2.22 (95% CI = 1.61, 2.98) among the study subjects and 2.29 (95% CI = 1.9, 2.67) among workers at the Great Belt Link. CONCLUSION: No significant progress was found in the incidence of disability pension among the study subjects despite substantial improvements in safety management compared with the Great Belt Link.

A nationwide population study of severe head injury and Parkinson's disease.

The aim was to analyze prospectively the association between severe head injury and Parkinson's disease. All people in Denmark who were at least 20 years old as on 1 January 1981 were followed for hospitalisation due to previous head trauma during 1981-1993 and for hospital contacts due to PD during 1995-2004. We observed 107 cases of PD among people at hypothetical risk due to previous head injury. The expected number was 112.1, which yielded a standardised morbidity ratio of 0.954 (95% CI: 0.782-1.15). The study provides no support for severe head injury among adults being a risk factor for Parkinson's disease.

Social inequalities in injury occurrence and in disability retirement attributable to injuries: a 5 year follow-up study of a 2.1 million gainfully employed people.

BACKGROUND: Inequalities in injury related disability retirement may be due to differences in injury risk and or differences in retirement given injury. The aim of the present study was to measure social inequalities in injury occurrence and injury related disability retirement. METHODS: All people in the Danish labour force aged 20-59 years 1 January 1997 were followed for injury related hospital contacts during 1997 and all people in the Danish labour force aged 21-54 years 1 January 1998 were followed for injury related hospital contacts during 1997 and for disability retirements during 1998-2002. As inequality indices we used excess fractions (EF) i.e. the proportions of the cases that would not have occurred if the risks in each social group had been as low as they were in the occupational group with the highest skill requirements. RESULTS: With regard to the risk that an injury will occur, the EF was 36% among men and 10% among women. With regard to the risk that an injury will lead to disability retirement, the EF was 43% among men and 47% among women. The combined effect of the two types of inequalities rendered an EF for injury related disability retirement of 64% among men and 53% among women. The correlation between the case disability rate ratios among men and those among women was low (r = -0.110, P = 0.795). CONCLUSION: The social inequality in injury related disability retirement lies only to some degree in the differences in the injury risk. More important are differences in the consequences of an injury. This was especially pronounced among the women.

Prioritizing occupational injury prevention in the construction industry: injury severity or absence?

PROBLEM: National occupational injury prevention goals often prioritize the reduction of serious injuries. This study analyzed whether this prioritization is credible in respect to lost-time injuries and short and long term work absence, and the implications this has for injury severity-based versus injury absence-based prevention approaches. METHOD: The data consisted of national and work-site specific injury and absence data from construction workers in Denmark, including workers from the Copenhagen Metro construction sites, during the period 2000-2001. RESULTS AND IMPACT ON INDUSTRY AND GOVERNMENT: Absence length was significantly dependent on the type of injury. Sprains and strains were most prevalent and accounted for approximately one third of injuries and absence. Fractures accounted for one sixth of injuries and the greatest proportion of long-term absence. The results give credibility to the need for targeting sprains and strains in injury and absence prevention initiatives.

Prospective analysis of disability retirement as a consequence of injuries in a labour force population.

UNLABELLED: The aim of the present work was to investigate the influence of different types of injury on the risk for disability retirement among economically active people in Denmark. MATERIAL AND METHODS: In this prospective study, all people in the Danish labour force aged 21-54 years 1 January 1997 (N = 2 211 057) were followed for disability retirement during 1997-2001. Age and gender standardised incidence ratios (SIR) were calculated to compare retirement rates among those who received treatment for an injury during 1996 (N = 252 468, including both work-related and non-work related types) with the rates in the total labour force. Life-table methodology was used to calculate years of lost economically active life (YLEAL) by injury type. RESULTS: Among the injured people we observed a total number of 5580 cases of subsequent disability retirement and 45% of these could be statistically attributed to the injury. The SIR for disability retirement by injury type ranged from 1.38 to 7.00. The least severe types, superficial injuries and dislocations, sprains, and strains, were most prevalent and generated the highest numbers of YLEALs. CONCLUSION: The high frequency of injuries and their influence on retirement rates suggest that injury prevention is a highly relevant approach to reduce future costs from disability retirement. YLEAL calculations can be used to set priorities.

Mortality and morbidity among bridge and tunnel construction workers who worked long hours and long days constructing the Great Belt Fixed Link.

OBJECTIVES: This study aimed at estimating the mortality and morbidity of hospital treatment among bridge and tunnel workers who worked round the clock, long hours, and long weeks to construct the Great Belt Fixed Link. METHODS: A cohort of all Danish workers in the construction industry was followed for death and first hospitalization and outpatient or emergency ward treatment over 6 years. Standardized mortality and morbidity ratios (SMR) were calculated for selected diagnoses, and 5123 bridge and tunnel construction workers were compared with all 109 383 Danish construction workers. RESULTS: The comparison showed an overall SMR of 124 with a 95% confidence interval (95% CI) of 97-155. For infectious diseases and intestinal infectious diseases, the corresponding values were 156 (95% CI 132-184) and 167 (95% CI 117-230), respectively. For diseases of the nervous system, it was 138 (95% CI 118-160), and including nerve, nerve root and plexus disorders it was 135 (95% CI 104-171), for instance, mononeuropathies of the upper limbs (SMR 136, 95% CI 101-180). The SMR was 139 (95% CI 126-153) for circulatory diseases, 157 (95% CI 130-189) for ischemic heart disease, 129 (95% CI 114-146) for diseases of the respiratory system, 124 (95% CI 114-135) for diseases of the digestive system, and 115 (95% CI 108-123) for diseases of the musculoskeletal system and connective tissue, including other intervertebral disc disorders (than cervical) (SMR 130, 95% CI 109-154). CONCLUSIONS: Bridge and tunnel workers who work round the clock, long hours, and long weeks have a mortality rate that is as high as that of other construction workers, and they are treated more often in hospitals.

Efficiency in reducing lost-time injuries of a nurse-based and a first-aid-based on-site medical facility.

OBJECTIVES: The purpose of the study was to evaluate the efficiency of two standards for on-site medical facilities in reducing lost-time injuries during the construction of the link across the Oresund sound between Sweden and Denmark. One medical facility employed licensed nurses, who had advanced medical assistance at their disposal. The other medical facility utilized first-aid-trained watchmen. The on-site medical facilities aimed both at providing immediate medical assistance to workers subjected to occupational injuries and at reducing lost worktime. METHODS: The distributions of injuries treated on-site (the worker resumed work after treatment) and injuries sent to hospitals or to specialists were compared for each type of injury and for each category of injured body part. RESULTS: The on-site medical facilities dealt, in particular, with the treatment of ocular injuries (21%), wounds (21%), and sprains or strains (15%). The study showed a statistically significant on-site treatment (and resume work) rate ratio of 3.3 between the nurse-based (76%) and the first-aid-based (23%) medical facility. CONCLUSIONS: The construction of the Oresund Link shows a need for on-site medical facilities, particularly at remote construction sites, and that it is essential that the medical personnel have both the qualifications and authorization to treat site-specific workplace injuries effectively in order to obtain high on-site treatment rates.

Industrial differences in disability retirement rates in Denmark, 1996-2000.

OBJECTIVES: The objective of the study was to identify industries associated with a high risk of disability retirement and to roughly estimate the fraction of the retirements that can be attributed to a non-optimum work environment. MATERIALS AND METHODS: All economically active people in Denmark, aged 20-54 years, in the beginning of 1996 (1196235 men and 1063058 women) were followed-up from 1996 to 2000. Gender stratified and age standardized incidence ratios (SIR) for disability retirement were calculated for each of 58 baseline industries. A Monte-Carlo simulation model was used to estimate attributable fractions. RESULTS: In total, we observed 17242 disability retirements among the men and 20910 among the women. The attributable fraction was 38% for the women and 40% for the men. Twenty-six of the SIR-values (13 among the men and 13 among the women) were statistically significantly high. Twenty-two of the 26 groups with a high SIR had been identified by previous research as groups at high risk of circulatory disease and/or musculoskeletal disorders. Two of the remaining four groups with a high SIR were associated with hard physical work (men and women engaged in horticulture and forestry) while the other two consisted of men in female-dominated industries (child-care and cleaning). CONCLUSIONS: The present study identified a series of high-risk industries. It also corroborated previous findings, which state that circulatory disease and musculoskeletal disorders are major risk factors and that hard physical work is an independent risk factor of disability retirement. Further research is needed to find out why men in some stereotypically feminine industries are at high risk of disability retirement.