Robert Pater and John K. Glenn
"Safety+Health" (July 1999)

Every day, workers in a wide range of industries engage in hand-to-hand combat--with their work, their tools and machines. So it's probably no wonder that our experience--with organizations such as Alcoa, American Airlines, Anheuser-Busch, Boeing, British Petroleum, Delphi Harrison/General Motors, James River Corp, Kodak, LTV Steel and many others--shows hand injuries rank among their most significant safety problems.

In fact, according to data from the Bureau of Labor Statistics, in 1996 there were 425,600 lost work day injuries to the wrists, hands and fingers; this accounted for 22.6% of all lost work day cases in industry overall. In manufacturing, hand injuries were even more prevalent, with these problems comprising 30% of all lost-time injuries. Our international clients have indicated their experience is similar.

Because many people have to work extensively with their hands, it's understandable that their wrists, hands and fingers would have a high exposure to injury. Further, when workers perform highly repetitive tasks, it's easy for them to be lulled into complacency. That is, until they suffer a severe or debilitating injury. These typically include: cuts, cumulative and acute strains or sprains, deep soft tissue injuries, nerve damage, dislocations, fractures, amputations or loss of the ability to use their hands effectively.

Clearly, past efforts to prevent these pervasive problems have shown limited success. Warren Brown is the Safety Manager of Delphi Harrison Thermal Systems in Moraine, Ohio. His 3,600-employee plant makes air conditioning compressors for General Motors cars. Warren indicated, "60% of our reportable injuries are hand injuries."

He further expressed, "We've tried all kinds of approaches to prevent these injuries--which result from lifting and loading, handling materials, or bumping against objects such as milling and other machines. What's been out there traditionally hasn't worked. We knew we had to try something new and especially an approach that helped our people control their attention while doing repetitive work."

The good news? It is possible to take matters into your own hands to help prevent these common problems.

Getting A Handle on the Real Problems

Start by understanding the traditional attempts to prevent hand injuries. (We are using the term "hand injuries" to refer to a full range of wrist, hand and finger problems as well).

Established approaches usually emphasize "environmental" interventions such as machine guarding and lock-out-tag-out, workstation redesign and use of PPE/gloves. While these strategies can help, they are clearly not the final answer; companies have continued to be plagued by these problems.

In our experience, for example, gloves can serve to protect a worker. But they can also become part of the problem. Some gloves don't adequately fit workers - gripping strength can be sizably reduced when wearing ill-fitting hand protection. Also, too-large gloves increase the risk of being snagged by equipment. In other situations, gloves can reduce tactile sense and interfere with performing precision work. For these and other reasons, many workers resist using gloves. When properly selected, utilized, and available, gloves can help reduce hand injuries. But they are not clearly not the final answer.

Yet other organizations have launched "pay attention" campaigns, either exhorting workers to think before they act or attempting to "scare" them into safe behavior. For example, the petroleum industry has historically experienced a significant level of hand injuries. Frustrated and anxious to reduce these problems, one international oil company created a visually graphic poster, depicting the hand of one of their employees whose four fingers were severed in an accident on a drilling platform. In an attempt to motivate other employees to work safer, this picture showed the injured worker's severed fingers laid out a few inches from the rest of his hand. While this poster indeed got some immediate attention, it was mostly negative. Employees reported becoming angry with management for seeking to capitalize on their coworker's injury in such a gruesome manner.

In addition to creating negative reactions, such shock tactics rarely create lasting positive change. Some people are immediately turned off by negative images. Other staff members may think "this has never happened to me" and dismiss these risks as not directly affecting them.

For preventing hand injuries, many safety professionals recognize the importance of workers maintaining focus during high-exposure work. But employing fear tactics to motivate continued attention often is doomed. Frequently, workers are readily distracted by such factors as time pressures, potential downsizing or personal concerns. And motivation through fear soon fades into the background when employees are going through the motions of mentally repetitive jobs. These people are at high risk of hand injuries.

Arming Your Staff

As traditional methods have shown limited success, what can you do to assist your people to prevent common and costly hand injuries?

Your hand-injury prevention mission, should you decide to accept it, is to help employees maintain high individual motivation, personal responsibility and control, as well as active thinking and judgment.

Programming for hand safety is a three-part process.

1. Identify Your Company's Contributing Factors in Hand Injuries
These include Environmental, Individual and Organizational factors.
For example, machine guarding is designed to prevent workers from coming into contact with moving, hot or sharp surfaces. However, we have seen where guard design has slowed access to the working area or blocked vision. Employees then felt impelled to circumvent the guards. While this is partly a problem of employee judgment, we also see this as poor guard design in that it disregards human nature, especially in highly demanding work environments.
Other environmental contributing factors might include:

1. Sharp-edged or otherwise uncomfortable workstations that discourage employees from getting optimally close to their work
2. Other workstation designs that obstruct best working positions
3. Heavy or awkward loads
4. High pacing, repetitive job design without sufficient variation
5. Distracters, such as background noise
6. Poor lighting
7. Poorly designed or dull cutting edges
8. Poorly maintained equipment in general

Individual contributing factors might include:

1. Fatigue, which slows reaction time, decreases alertness or causes workers to rest their hands in at-risk locations
2. Poor posture. This can inhibit full breathing and alertness
3. Lack of awareness of hand position. In our experience, most people are not equally aware of both of their hands while working. This can lead to increased danger to their "off-hand."
4. Body positioning that can place workers at higher exposure
5. Poor balance, which can result in employees reaching out with their hands to steady themselves, potentially in a dangerous area
6. Stress, either at work or at home. This narrows attention from the task at hand.
7. Poor judgment, such as not knowing current limitations or understanding actual risk factors
8. Complacency or overconfidence. This attitude can lead to reduced alertness to real risks and contributing factors in hand injuries
9. Poor vision and other personal health concerns.

Organizational contributing factors might include:

1. Company history of ignoring or denying persistent injuries or real risks
2. Lack of a system for ongoing identification and follow-up of specific contributing factors and concerns
3. Inadequate employee training
4. Lack of training for supervisors on their critical role in hand injury prevention
5. Where unionized, not getting bargaining unit leadership aligned towards hand injury prevention programming
6. Motivation that actually demotivates safety awareness, strong use of technique or participation in problem-solving

2. Plan Your Hand-injury Prevention Objectives:
We suggest considering:

1. Setting realistic short-term and long-range goals for measurable improvement in hand safety. These should include reportable attitudinal acceptance, observable behavioral change and statistical measurements.
2. Monitoring effective maintenance schedules.
3. Reducing other environmental contributing factors in hand injuries as noted above.
4. Training managers, supervisors and workers as appropriate.
5. Eliciting active involvement of unions, workers, medical staff, safety department and management.
6. Approaching worker hand safety in a positive rather than a threatening manner.
7. Inducing personal staff responsibility without backlash.
8. Providing employees specific techniques to master changing conditions.
9. Helping workers who feel at the mercy of highly paced processes develop the ability to focus their attention.
10. Offering methods that apply to home as well as to work. People are creatures of habit--it is critical for successful hand injury prevention to instill positive default behaviors that will transfer between work and home activities.
11. Developing a system for ongoing reinforcement and behavioral improvements in hand safety.

3. Implement a System So Workers Become HandSMART™:
When you have both a better understanding of obstacles to hand safety and know what you want to accomplish, the next step is to implement an effective program for prevention.
The list of environmental and organizational contributing factors above will suggest methods for positive change. For example, on the "Environmental" side, consider having safety committees, union leaders and key staff professionals involved in audits that interview workers to determine critical risks.
"Organizationally," educate managers and supervisors toward active involvement in hand safety. Show them how this will help them realize their broader objectives (morale, cost-containment, scheduling, production, quality, etc.) The key is to get them interested and energized.
But for most companies, training and education is the key to hand safety. This is achievable. The following strategies and techniques can make a significant difference in boosting hand safety.

1. Raising awareness of identified environmental and individual contributing factors in hand injuries
2. Teaching physical techniques that boost workers' awareness of where their hands are at all times.
3. Focusing on physical methods for improving attentional control, alertness and reducing fatigue. This is more potent than merely telling people to "pay attention."
4. Motivating employees to take personal control of their own hand (and overall) safety.
5. Improving spatial awareness through visual techniques
6. Demonstrating position and alignment methods for safely transferring forces. For example, how workers position their feet will make an immediately noticeable difference in their reaction time. In addition, the way they align their elbows and upper arms can markedly affect their hand coordination and strength.
7. Showing practical applications of how properly gauged distance can work for, not against, the employee
8. Arming workers with recovery strategies to minimize damage from potentially disabling situations. Where a "bailout" is needed, self-programming the employee to immediately move their hands safely. But emphasis should always be on avoidance of danger.

Hand injuries can be persistent, frustrating and costly in a wide range of industries. Traditional approaches have not solved this ongoing problem. But applied to their daily hand-to-hand work, an innovative and practical planning and training strategy can arm your employees with the weapons needed to work safer and more in control.