Rab Cross, Cross Associates
MR. McCAULEY: Our next presenter is Dr. Rab Cross. Dr. Cross or Rab, as he likes to be called, received his medical degree in 1973 from the University of San Francisco. He did his undergrad in engineering and applied physics. Then he went into the occupational medicine and has been there since 1984. He was nationally certified in ergonomics in 1994, and now he has set out in the wild blue wonder as a consultant with clients in office construction and manufacturing. Dr. Cross.
DR. CROSS: Thank you, Jim. This presentation is about manufacturing ergonomics, and the company that I represent is called Lunt Silversmiths. It's located in Greenfield, Massachusetts which is in the western part of the state. Lunt employs about 100 individuals in the manufacturing area. It is non-unionized. They manufacture flatware and hollow-ware, high quality silver-plated products, and they have many high-end customers to whom they market.
Lunt Silversmiths in the winter of 1992 got a wake up call after a meeting of the Board. It turned out that they had been losing over the years an awful lot of money in workers' compensation. They contacted me and asked me if I would explain to them what on earth ergonomics was, and maybe they would be interested in doing something in the ergonomics area at their company.
So I sat down with them, and we decided that initially, we would do the following: analyze the OSHA 200 Log; discuss with HR, plant management and supervision the fact that I was going to be going out and observing the jobs, taking pictures of people and getting some good input from the employees, what bothers them, what hurts them, how they've gotten hurt, how have other people gotten hurt in the past.
The records analysis, primarily the OSHA 200 Log was very telling. I did one from '84 to '92. And in summary, back injuries were number one, with 640 days lost, and they clustered in three departments, the making room which is where they make their product, the machine room where they fashion the dies used in the presses and the stamping machines, and the hollowware department where they handle larger items that are silver plated.
The record review also showed some significant wrist injuries with 235 days lost. They occurred in the trim room, the cutlery room and the hollowware room, and all three of these rooms share in common the fact that they are working with polishing wheels, grinding wheels, buffing wheels, coloring wheels, seated or standing, holding the product against, usually cloth wheels, for various kinds of finishing.
The CFO calculated the direct costs and the indirect costs and looked at his financial records, and he was getting upwards in the neighborhood of seven figures that were lost to this problem of workplace injuries. So he felt that something had to be done, and to his credit, he decided to convince top management to bite the bullet on this whole issue of workplace injuries and ergonomics.
Well, it was agreed that I would take my slides from the workplace, and I would provide some training and education to supervisors and employees, engineering and maintenance. HR would be there for each presentation. We were going to share right up front with the employees what the statistics were. The employees were going to look at slides of themselves as they work. I would use some illustrated anatomy slides, and I would use 2-D and 3-D which are bio-mechanical programs, to simulate these people in their various tasks and see what the back and extremity forces were.
The goal was to enlist some participation by everybody in turning around the rather dismal statistics they'd had at Lunt Silversmiths.
We went out first of all to the machine room. This is Russell Dodge, and Russell is holding a die, a part of a die. The die is what they put silver stock or brass stock on, and then various types of presses or stamping machines pound out the product. I said, "Russell, why are you carrying that? How much does it weigh?" "Aw, Rab," he said, "It weights about 50 pounds." I said, "Come on, come on, Russell. Let's go weigh it." Well, it turned out to weigh 96 pounds. Had people been hurt lifting these dies? You bet they had, and they had tons of them. I mean, they have dies, dies, dies, dies and dies. And some of them are big, some of them are small. They're generally stacked on shelves from floor to 10-12' high.
Generally, it had been the custom for one person, or maybe two people, to lift these by hand, carry them to the work benches, clean them up, polish them up, put them into use, and then after they had been used, bring them back and stack them on the shelves again. Many of these weight well over 100 pounds, some in the neighborhood of 150 pounds. These were very heavy lifting tasks that correlated with the statistics of injury.
A second area where some back injuries had occurred was in the molding room, handling lead ingots. An employee had ruptured a disc picking up these boxes of lead ingots. Unfortunately, he didn't pick them up just single-handedly by brick. He picked up a big box of ingots. We simulated that with biomechanical software.
Without spending too much time on the program, you can basically put a person into the position representative of their job. You can simulate their task. You can enter the weight that they lift, the number of hands they use, what angle of force they're applying. You can even put in the individual height and weight, and thanks to the computer, just push F4.
In the bottom right-hand corner is a rectangle representing lumbar disc forces. The first third represents low risk forces. The middle, third, is a questionable area. The far right third of the rectangle represents significant risk of disc rupture. With this simulation, there is high likelihood of rupturing a disc doing that task. And sure enough that's what happened to the individual who was involved with the lead ingots.
There's a scar on his back from disc surgery. He, in fact, required a fusion. This slide shows where they took bone grafts from his low back. So the biomechanical prediction is borne out. It was a terribly high risk job that we identified. (Top management had to sit down and agonize through all these slides with me preparatory to investing money in equipment and job changes.)
Part of my message to the employees during the training program was, "The Older I Get, the Better I was." Now, the way I twist that around is people do a lot of stupid things when they lift. And particularly, males have a terrible macho attitude toward lifting. Remember, Russell said, "Oh, it's 50 pounds." Well, it was 96 pounds. The macho attitude traverses generations of employees. The older guys expect more out of the younger guys, and the younger guys try to put out and then they hurt themselves, and it continues. The cycle has to be broken.
Emphasize to the employees, stop lifting such heavy objects. People are getting hurt. Look at yourself. Look at the people around you. Look at the statistics. Let's do things differently.
So they did things differently. These are two lift devices that they used. Here is one of the dies that they had been carrying around by hand for decades and decades. Now they use lifts all the time. Lunt bought several of these lifts. And one of the employees called me just the other day knowing I was coming out here. And he said, "You know, Rab, the best thing you ever did for us in the machine room was to get those lifts. We don't lift these dies by hand anymore." And they haven't had a back injury out there since.
Those dies are made out of steel. And the steel is delivered to the company in this little back entrance. It's off-loaded from trucks, and they slide these big long bars of steel down this little chute into a basement area known as the steel room.
These big, heavy, heavy bars of steel slide down the chute and out on the racks. There is a chain fall used to move each bar. Bars eventually are brought over to saw and are cut into small lengths of steel. They then take these lengths of steel, and they put them through tempering and hardening processes. This bar weighs 90 to 100 pounds, the bar Ernie is indicating in the slide.
In the past, employees would grasp these pieces of steel with tongs. Here's Joey holding a bar with a tong over one of the heat treatment furnaces. He would slide the bar down in the furnace and later pull it out again. There's some tremendous potential for shoulder injury. During training, I said to Joey, "You know, there's a high likelihood that you are going to severely strain the muscles in your shoulder, if not have a rotator cuff injury. And if your shoulder fails, then, the strain are going to be translated into your upper mid or even lower back." I said, "Joey, I don't know the answer, but you need to fix this."
I returned to the steel room several months later to see that they now have a metal track that runs overhead from furnace to oil quench. In that track, they've got a pulley suspended. They handle these pieces of steel in a two-man process, using a pulley and tongs attached to a cable that goes on the pulley. One person will pull on the end of the cable, thereby holding the weight of the steel. He has mechanical advantage thanks to the pulley. Meanwhile Joey guides the steel down into the furnace and later brings it back out again.
"So what do you think, Doc, did I reduce my risk?" I said, "You did a wonderful job, Joey. I wouldn't have known what to do or how to do it." These employees have great mechanical knowledge, and they can convert my ideas into equipment! That's one reason I enjoy working closely with employees.
Getting down into the cellar place was not easy. There's this circular stairway. It's like a DNA helix coming down. One of the things that these employees did was carry down heavy bags, 80 or 90 pounds of steel chips. They use these chips in some of their gnneslling process. Well, they had to use two hands to hold onto the bag. (Obviously, they weren't using one hand to hold onto the rail, so it was a dangerous process indeed.)
Just recently they showed me their latest innovation. Here is a large box, down in the cellar; and here is a chute, coming down from the top level. Now, upstairs, employees will take the bag of these chips, dump them down a little hole (which is disguised as a heat vent) right down through the chute and into the box downstairs. Pretty simple, works well, no fuss, no muss, no back injuries and no falls down the stairs.
It used to be they were just a silverware company. Recently, they purchased a stainless steel flatware company. And this is the new warehousing area. The warehouse workers had pallet movers and box movers, but there's no lift equipment. There are a number of racks or shelves where they store boxes of stainless steel products. And the bigger boxes they set in different areas to unload them as they need.
Well, they were expecting these huge shipments to come in, so they were moving these large boxes out of the way. George injured his back placing one of these big boxes up into a very awkward area. Two men did the process, but they were lifting and twisting while stacking this box, which was 160 pounds, up at about shoulder height. Fortunately, George did not have a serious disc injury, but he required restricted duty for some time.
The obvious solution was to get a lift. They've already obtained a lift in the warehouse; that happened quickly. (They don't want to go back to the era of back injuries again.) Furthermore, now George is using a back belt. I'm not the biggest fan of back belts. I think they're over-used. I think they're misused. I think there's a lot of hype to them, but they can keep you from twisting into disadvantage positions and postures. And so, the employees in the warehousing area, are offered back belts (with some instruction from me about bio-mechanics and reasonable expectation for lifting and strength).
As part of the ergonomics process, I used subjective questionnaires. Regarding sore backs, a consistent complaint was made about the chairs. "Doc, we need better chairs. These things are killing us."
This is one of the old-style chairs that they had. It is hard with a minimally adjustable back, hardwood seat, nothing contoured whatsoever, providing minimal lumbar support.
Most grinding operations were performed seated. You can see how little back support one gets from the chair. This employee gets support only from one little part (digging into his back). And this was true for most employees in the manufacturing era.
Here is one of the typical old chairs. Russell had padded his with a cushion from high school that his son brought home, and he's been sitting on that cushion for many years. He'd worn it right down to nothing.
Well, the recommendation to Lunt was that they needed better chairs.
So they selected, with my recommendation, chairs from Tiffin. They chose a height adjustable chair. The backrest is nicely adjustable. The seat pan will lengthen, and the seat pan will also tilt, and there's an optional ring for leg support on the chair.
Here this employee is sitting in one of the new Tiffin chairs. He experienced back problems and missed almost a year of work (a non-work related back injury). He truly appreciates his new chair, being able to change adjustments for his tasks and maintain back support.
And here's Gary Jefferson. Gary also has had back problems over the years. In fact, he used to work standing, because he couldn't sit for long in the old chairs. But he too loves his Tiffin chair. He uses it. He uses the controls. He changes adjustments as needed, and he even has an inclined foot rest. So after the lift devices, good seating for the manufacturing area has been one of the best improvements for reducing back complaints.
The OSHA 200 log indicated some neck injuries. (This is another illustrated anatomy slide that I used with employees during training.) Neck injuries were generally not severe, but rather a lot of muscle strains. Also several employees had non-work related cervical problems, and were experiencing aggravation in the workplace.
Here's one example. This is Norm McCloud, and Norm is doing a finishing operation on handles. And I think you can appreciate his head and neck are almost bent over to 90 . And he said, "Rab, my neck and shoulders are just killing me from doing this." And so, I approached the maintenance team, who have been extremely helpful in terms of implementing my recommendations.
Maintenance developed an inclined adjustable support for the little jig that Norm uses as part of his finishing process. He holds the handle against the jig and then operates a powered tool for the grinding process. Now that he uses the inclined support, Norm has straightened right up. The inclined support is used to this day without any further complaints of neck problems. Simple solution. I can't tell you how much that cost, but it certainly is not over $20 or $30, including the time to make it.
Maintenance was also were very helpful to Jerome. Jerome said, "My back is killing me." As he loaded racks with flatware, he was bent way over, due to a low table. He said, "You know, I've been complaining about this table for a couple of years. It's killing my back." Shortly thereafter, maintenance brought the height of the table way up. Jerome no longer bends over. Simple intervention, minimal cost, a couple of pieces of pipe basically put onto the table legs to raise it up.
Not all problems are simple. In particular, cumulative trauma disorders are not simple, and I'm not here to tell you they are.
This is an employee from Lunt Silversmiths, and that's a scar on his hand. This is a post-surgical scar from Carpal Tunnel Syndrome. This was a longstanding problem and, gradually, he had tingling, pain, numbness in the hand, and then he got power loss. When one gets power loss, one needs surgery. So he had an operation.
But he lost minimal time. This employee wants to work, even after surgery. He's not interested in going out on comp. He's got splints on both wrists. He's pushing around a cart of flatware from one area to another, even wearing these splints. He's been an example for the entire plant. And he is probably going to have to have surgery on his left wrist as well. He got this from wheel work, working against the wheels doing buffing, polishing operations.
This is one of the illustrated anatomy slides that I used in the training for the employees. There's a terrible amount of misunderstanding and lack of knowledge as to what these cumulative trauma injuries are, what's Carpal Tunnel Syndrome, what are the tendons, where are the nerves? So I can show them, for instance, that many of the nerves start up in the neck, come out through the armpit, course down through the arm, run through the elbow, down the forearm, through this small area in the wrist which is the carpal tunnel, and go down to the fingers.
There are also multiple tendons in the wrist, in the elbow and in the shoulder, as seen in this anatomy slide.
And here is the slide I use to explain Carpal Tunnel Syndrome. True Carpal Tunnel Syndrome means that the nerve going through the wrist, called the median nerve, has been traumatized, compressed, blood supply cut off. This results in pain, tingling, numbness in this distribution, the thumb, index, middle and part of the ring finger, mostly on the palm of the hand.
My point to employees is that there are two phases of Carpal Tunnel Syndrome. There's an early reversible phase, often intermittent, characterized by tingling in the fingers and hands, numbness in the fingers and hand, pain in the wrist, and stiffness. These symptoms occur at nighttime and at rest. Early reporting means that employees must speak up sooner rather than later. The symptoms are not normal, and very likely fixable in the early stage. On the other hand, if people get to the late stage, they're often surgical.
The symptoms are persistent. People have hand and finger pain and numbness. They get clumsy handling things. They have power loss, muscle atrophy. They lose that muscle at the base of their thumb. They become surgical cases. The goal is to keep people from surgery by getting them to report early. And you know, that works.
This is Larry. Larry came to me several months ago, And said, "Rab, my forearm is killing me." Fortunately, as a physician, I have the opportunity to examine these people as well as hear their complaints. So I examined Larry, and I determined he had tendinitis in his elbow, known as tennis elbow or a lateral epicondylitis. I suggested he get a tennis elbow splint, which he did, and has been wearing it and has been working with it.
Now, how did he get that injury? Shoveling snow back in Massachusetts is how he got it. It was primarily non-work related. However, in Massachusetts, if your job reasonably contributes to even a small percentage of your injury, then the employer may be held responsible. Fortunately, we were able to intervene quickly, and avoid any serious problem. He's been working steadily, not in pain, and his elbow is getting better.
Another employee came to me several months ago. He said, "Rab, you know, I'm having a lot of pain in my wrist and forearm." I examined him, and determined that he had tendinitis in his wrist. He did not have Carpal Tunnel Syndrome. I went to look at his job, the one he said was bothering him. He uses a small power saw for trimming the edges of handles, and he was in the habit of accumulating seven, eight, nine, sometimes even ten handles in his hand progressively as he finished them. So he tended to stack them up in his hand, grasping them tightly.
So he was continually gripping, exerting constant force and using the flexors in his wrist. The solution was a little change in job performance. We put a small box near the saw, very close to the operator. He learned to hold only one blade at a time. The pain in his wrist went away. Again, early reporting makes avoidance easier.
Here's a clamping operation. This shows Gary. Gary actually ended up in trouble from a clamping operation, repeatedly closing vice grips. The handle hit right on the palm, right over the area of the Carpal Tunnel, right on the media nerve. The clamping task had been done by hand for many decades.
An engineering consultant developed a fairly simple tool which, when pressed down on the top of the vice grip handles as it hits across the top of the vice grips, the clamping operation occurs without manual squeezing. It took a little time to convince employees to use this, because they were used to doing the job manually. We hope that problem has been eliminated. Even so, employees use some impact gloves on their hands, so I believe they still perform some of the clamping by hand.
The biggest problem at Lunt Silversmiths for upper extremity injuries and Carpal Tunnel Syndrome, is working with wheels. Wheel work was worse before they had adjustable chairs. But even with the chairs, the task remains very hand-wrist intensive.
There's no way that they are going to eliminate manual finishing. Tiffany buys this flatware, so it has to be finely finished. When using wheels, the wrists are angled, they're twisted, they're moving around, they're gripping. Finishing is repetitive work, day after day, after day.
Now some employees have done it for decades and no problems. Other people get in trouble. I'm of the opinion that the answer has to do with balancing these employees in their work station and getting them so that they can adjust and adapt back and forth from one position to another. I find that inches and angles make quite a difference for these upper extremity injuries.
One approach was to get an adjustable table. The finishers like it, and have requested several more adjustable tables for some of their pumice box operations. This table is crank adjustable so they bring it up and down, raising and lowering the wheel. (Mike, who uses the table, swears he won't part with it no matter who's having trouble throughout the company.)
Most finishers now use an inclined footrest along with the adjustable Tiffin chairs whether work is done at a computer or a grinding wheel, there's nothing like an inclined foot rest. It keeps your back against the back support. Many finishers also use an arm rest that was made in-house. It's adjustable up and down. It will also adjust horizontally. The employee can adjust to different positions depending on the size of the product being finished. Finishers also needed better illumination. They got some additional lights so they can see better and don't have to bend their head down as much.
To reduce hand force, Lunt is experimenting with different grades of pumice. They have determined that the supplier changed the pumice material about three years ago, and it's a finer pumice. It doesn't abrade as well, so finishers are having to bear down harder, using more hand force. And so, they're looking at going back to the old style pumice again; this may require less hand force.
So what's the bottom line? The bottom is that total injuries at Lunt have dropped down nicely from 35 to 17 in four years. The total lost work days have dropped considerably from over 300 to less than 50. With total lost work days reduced, that's bound to save a lot of money.
I analyzed the injuries by types: cumulative trauma, back injuries and then "other". Other injuries are primarily lacerations with a few dermatitis cases. The back injuries went from 7 to 3 to 2 to 2. The upper extremity problems are 13, 16, 10 and 10 - dropping slowly. And even the "other" injuries dropped down very nicely.
I have also analyzed lost-time injuries versus no lost-time. Lunt went from 7 lost time injuries to 8 lost time injuries to 4 lost time injuries and then no lost time injuries.
We can further show that of those lost day cases, The number of lost work days per lost day case has dropped. The number of restricted days per lost day case has increased. So supervisors are more consistently using the employees for restricted duty work. Employees continue to report symptoms early.
There has evolved a nice parallel between the total lost days and the total lost workers' comp dollars for Lunt. They went from $192,500 now down to $27,100 expended for worker's comp costs. The money saved has more than paid for my time and for the ergonomic improvements that have been made.
The Lunt experience has been a success story. Lunt is pleased with the results of the ergonomics. The employees are pleased with the improvements. Even the head of manufacturing is pleased with ergonomics, because it's not disrupted his production. Lunt has agreed to have a continuing process of ergonomics. (Not a project, not a program, not a one shot deal.) It's a continuing process, as Lunt develops new product lines and employees do new tasks.
It's been a pleasure working at Lunt Silversmiths. It's been a pleasure for me medically as well as in terms of ergonomics to see that these employees don't continue to have so many injuries that cause lost days or require medical attention.
Thank you very much.
