Friday, 23 September 2016 12:11

Causes and Symptoms of Fatigue

To Counteract Fatigue, it is Important be Familiar with Some of its Main Causes and Symptoms.

Common Causes of Fatigue

  1. Sleep deprivation: Not getting enough sleep is probably the most common cause of fatigue. It’s important to keep in mind that there are different reasons for being sleep deprived, including:
    • Extended time awake. How long has it been since you slept? After being awake for 16 consecutive hours most people begin to feel tired.
    • Reduced time asleep. Most people need between 7-9 hours of sleep to be at their best.  
    • Disrupted or poor quality sleep. Whether it’s a baby waking you up every 2 hours or back pain that prevents you from getting comfortable, not getting good quality sleep can lead to sleep deprivation.
    • The cumulative effect of multiple days with shortened or disrupted sleep – Has it been a couple of days since you last slept well? This type of sleep deprivation could put you at greater risk for feeling fatigued. 

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The simple answer is yes. Here's why:

1. Your workers are not machines – they are humans.

2. Humans aren’t designed to work outside of our “operating limitations

3. Once our human operating limitations have been reached, we are at an escalated risk for errors, accidents and productivity losses.

4. The outcomes of human errors and accidents can be catastrophic.

As Dr. Martin Moore-Ede stated in his book, The Twenty-Four-Hour Society, “People don’t release smoke, grind gears, or have pieces fall off; but their equivalents – fatigue, error, injury, and ill health – do result in failure and breakdown."

Reason’s Approach

James Reason, a distinguished professor and author, developed the ‘Swiss Cheese Model of Accident Causation’ to illustrate that although multiple layers of defense lie between hazards and accidents, flaws, or ‘holes’, can exist in each layer. When these “holes” align, a pathway accidents emerges (Figure 1).
swiss cheese model of defense

Given the nature of operational defenses, holes in the defense layers are dynamic and constantly opening, closing, and shifting within an organization – requiring an organization to continually re-evaluate the integrity of their defense systems.

When applying Reason’s logic to fatigue management, a fatigue-related accident or incident is the end point of a causal chain of successive lapses in a defense system. Therefore, an organization is responsible for developing a comprehensive defense system against fatigue; while its employees are responsible for arriving to work alert and fit-for-duty.

Applying Reason’s Logic to Fatigue Risk Management Systems

Reason’s Swiss Cheese Model of Defense was used to develop the model for comprehensive fatigue risk management systems (FRMS), which is now the international standard for managing and mitigating fatigue in operations (Figure 2).

CIRCADIAN '5 Defenses' FRMS Model
Fatigue Risk Management Systems

Interestingly, fatigue has a global cost to employers of over $100 billion per year, yet CIRCADIAN surveys reveal that only 10% of organizations have implemented a comprehensive fatigue risk management system. 1-2

This means that despite the overwhelming evidence that an FRMS is necessary for optimizing the safety and profitability of an operation, many organizations are choosing to forgo implementing these critical systems. But why?

Some would suggest that this counterintuitive behavior is a result of our optimism bias.

The Dangerous Optimism Bias

Optimism bias is a cognitive bias that causes a person to believe that he or she has a lower risk of experiencing a negative event compared to others.

When applied to operations management, the optimism bias can prevent managers from implementing the safety measures necessary to prevent a fatigue-related accident.

So how do you overcome this bias to ensure the safety of your operation?

Overcoming the Optimism Bias

To overcome the optimism bias, start by asking yourself the following key questions:

1. Is your operation understaffed?

2. Is your workforce’s overtime rate (actual weekly hours worked/scheduled weekly hours) consistently above 12 percent?

3. Do a few key employees work most of the available overtime?

4. Do your workers complain about the shifts they work?

5. Is there a high degree of shift swapping among your workers?

6. Are your workers exhibiting any of the common symptoms of fatigue? Have workers mentioned being tired or struggling with fatigue?

7. If you run 8-hour shifts, are your workers allowed to work more than 7 days in a row? If you run 12-hour shifts, are your workers allowed to work more than 5 days in a row?

8. Does your operation experience high rates of absenteeism and/or turnover?

9. Do more accidents and injuries occur on night and weekend shifts as compared to day shifts during the work week? Have you been experiencing higher rates of accidents/injuries in general?

10. Does your operation have excessive workers’ compensation claims?

If you answered yes…

If you answered yes to any of these questions, you should consider having a conversation with an expert to determine if your operation is facing serious challenges to its overall safety. If you answered yes to more than one of these questions, you should talk with an expert.

At this point, you may be telling yourself that now isn't the right time for that conversation – maybe later, next quarter, next promotion. Whatever it is that you're telling yourself to validate your procrastination – stop. Take the first step towards a safer operation – right now.

It’s easy to fall prey to optimism bias, however, disasters like Chernobyl, Three-Mile Island, and the 2005 Texas City Explosion are solemn reminders that fatigued workers can inadvertently make poor decisions at any moment that can result in grave consequences.

History tells the unfortunate tale of too many operations that chose to ignore worker fatigue and suffered catastrophic destruction, sky-high costs and even loss of life.

Clearly it’s time to make fatigue management a priority, if you haven’t done so already.

Workforces that have implemented a comprehensive FRM benefit from improvements in worker productivity, absenteeism, turnover and excessive overtime – along with many other added benefits.

These systems often accrue significant ROIs for companies, as was the case with Dupre’ Logistics (see below).

fatigue risk management

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Sleep deprivation is an issue that is often ignored, yet frequently the root cause of decreased productivity, accidents, incidents and mistakes which costs the global workforce billions of dollars each year.

Often times, managers and supervisors misattribute fatigue-related operational errors as isolated events caused by a single individual, rather than a systematic failure. Other times, increased accident rates and workforce problems are dismissed as being unrelated to worker fatigue.

Using logic presented by James Reason, a distinguished professor of psychology at The University of Manchester and author of many important books, including Human Error (1990), we can better understand the root cause of fatigue-related errors.

Analyzing Fatigue-Related Errors with Reason

James Reason proposed two possible approaches to the problem of human error: the person approach and the system approach.

The person approach focuses on the premise that an error is caused by a single individual, whether it be due to forgetfulness, inattention, negligence, and other personal lapses.

The system approach focuses on the premise that humans are fallible and errors are to be expected; therefore, errors are consequences of systematic failures and the root cause of errors ultimately falls on the system rather than the individual.

Reason developed the Swiss cheese model of accident causation to illustrate that although multiple layers of defense lie between hazards and accidents, flaws, or ‘holes’, can exist in each layer. When these “holes” align, a pathway emerges for accidents to occur (Figure 1).

Figure 1. James Reason’s Swiss Cheese Model
James Reason Swiss Cheese Model

Given the nature of operational defenses, holes in the defense layers are dynamic and constantly opening, closing, and shifting within an organization – requiring an organization to continually re-evaluate the integrity of their defense systems.

Using Reason’s logic, operational control should be focused on changing the conditions under which individuals work rather than trying to change each individual. Under this model, incident investigation should focus not on who made an error, but rather how and why the systematic defenses failed to prevent the incident.

The How and Why of Human Error

Holes in the defense layers arise from two outcomes: active failures and latent conditions. Active failures are the dangerous acts of individuals – such as: lapses, errors, or procedural deviations. The impact of active failures on the integrity of a defense system are usually temporary.

Latent conditions are the result of decisions made by the management team of an organization. These decisions may lead to unfavorable conditions – such as understaffing and excessive overtime – that can lead to long-lasting weaknesses in the defenses (i.e. fatigued workers, unworkable procedures). Latent conditions can go unnoticed or ignored for many years, even though latent conditions are generally easier to identify and rectify than active failures.

Applying the Swiss Cheese Model to Fatigue Management

When applying Reason’s logic to fatigue management, a fatigue-related accident or incident is the end point of a causal chain of successive lapses in a defense system.

At the end of the day, both an organization and its employees share a responsibility to prevent fatigue to maintain a safe operation.

An organization is responsible for developing a comprehensive defense system against fatigue; while its employees are responsible for arriving to work alert and fit-for-duty.

Developing an Effective Fatigue Risk Management System

A fatigue risk management system (FRMS) is a data-driven, risk-informed, safety performance-based program that reduces the risk of fatigue-related incidents in 24/7 operations. An FRMS continually monitors and reduces fatigue risk from both an organizational and individual approach.

An effective FRMS builds upon organizational policies and procedures to monitor, mitigate, and report worker fatigue and fatigue-related incidences.

When developing or reviewing an FRMS, an opportunity exists to identify the presence (or absence) of necessary defense mechanisms in the FRMS. A fully integrated FRMS provides five equally-critical layers of defense (Figure 2):

  1. Workload-staffing balance
  2. Shift schedule optimization
  3. Employee fatigue training and sleep disorder management
  4. Workplace environmental design
  5. Fatigue monitoring and alertness for duty

Figure 2. CIRCADIAN® 5 Defenses FRMS DesignFRMS

A successful FRMS also has the following seven key characteristics (Lerman et al.):

  1. Science based – Supported by established peer-reviewed science

  2. Data driven – Decisions based on collection and objective analysis of data

  3. Cooperative -- Designed together by all stakeholders

  4. Fully Implemented – System-wide use of tools, systems, policies, procedures

  5. Integrated -- Built into the corporate safety & health management systems

  6. Continuously improved – Progressively reduces risk using feedback, evaluation & modification

  7. Owned – Responsibility accepted by the entire management team of an organization

The seventh key characteristic, management ownership, is particularly critical as the development, implementation, and management of a FRMS requires the involvement of multiple departments of an organization.

Because of this, it’s important that the entire management team of an organization embraces a commitment to fatigue risk management as a critical component to the organization's overall safety and health management system.

Through properly implementing a comprehensive FRMS, an organization stands to significantly reduce the safety risks and profit losses associated with fatigue in a way that provides a win-win scenario for both management and workers.

White Paper: Evolution of Fatigue Risk Management Systems

Download your copy of our white paper “Evolution of Fatigue Risk Management: The “Tipping Point” of Employee Fatigue Mitigation” to learn more about implementing operational defenses against fatigue.

Fatigue Risk Management White Paperdownload fatigue risk management white paper

About CIRCADIAN®

CIRCADIAN® is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock. Through a unique combination of consulting expertise, research and technology, software tools and informative publications, CIRCADIAN helps organizations in the 24-hour economy optimize employee performance and reduce the inherent risks and costs of their extended hours operations.

Fatigue Risk Management System

Tuesday, 21 April 2015 16:06

Managing an Aging Workforce

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Researchers at Georgetown University predict that the U.S. economy will face a shortage of 5 million workers with the necessary education and training by 2020.1

Shiftwork & Aging Workers

For shiftwork operations with older workforces, the three critical questions:
  1. Is our operation facing an impending labor shortage?
  2. How do we retain our highly-skilled senior workers?
  3. If we retain our senior workers, what safeguards must be employed?

Impending Labor Shortage

For shiftwork operations that depend on senior workers, it’s a good idea to strategize a solution for the potential labor shortage in advance. Your operation can:
  1. Space out multiple retirements over a period of years
  2. Implement training programs for more junior employees
  3. Encourage senior workers to delay retirement

Shift Work, Aging, and Safety

A common misconception among shiftwork operations is that older workers develop more problems with shiftwork as they age.

In a review of research that focused on the effect of age on the sleep, fatigue, performance, accident rates and health of shiftworkers, the findings were mixed:

Two studies reported more problems in older people, four studies reported opposite results, while in five studies no significant age-shift work interaction was observed. From across-shift comparisons (six studies), it was deduced that older compared with younger workers have more sleep problems with night shifts, while the opposite is true for morning shifts. This review did find some differences between older and younger workers, but did not find evidence for the suggestion of more shift work problems in older workers.2

Sleep and Aging

Sleep itself has been found to be directly affected by age. With age, it becomes harder to fall asleep, stay asleep, and achieve restorative amounts of sleep.

On a related note - our circadian rhythms begin to slowly shift backwards as we get older, normally beginning in our early twenties. This means that throughout our lifetime, we progressively wake up and go to bed earlier and earlier. For some people, the natural morning wake-up time can change by as much as two hours throughout their lifetime. This increase in “morningness” (i.e. earlier wake-up time) can make it harder for shiftworkers to sleep during the daytime.

Along with increased morningness, circadian rhythms become less flexible with age. Coping with shift changes can become more difficult with age, as it takes longer to adjust to working at night after several days off. However, as previously mentioned, aging doesn’t necessarily result in additional problems with shiftwork.

REFERENCES

  1. Allie Bidwell, “Report: Economy Will Face Shortage of 5 Million Workers in 2020” U.S News and World Report, July 8, 2013
  2. Blok MM and de Looze MP. “What is the evidence for less shift work tolerance in older workers?” Ergonomics. 2011 Mar;54(3):221-32
Tuesday, 14 April 2015 14:48

Workforce Fatigue: 5 Must-See Graphs

1. Fatigue levels and worker’s compensation costs

CIRCADIAN’s Shiftwork Practices Survey revealed that fatigued workers exhibit up to 4x the worker’s compensation costs as compared to non-fatigued workers.1

Figure 1 shows the average cost of worker compensation claims per employee per year paid in 24/7 industrial and transportation operations with levels of employee fatigue ranking from low to high.1

Figure 1. Fatigue Levels and Worker’s Compensation Costs1

worker fatigue and workers compensation costs
 

2. Prolonged wakefulness compared to alcohol use: effects on alertness

Sustained wakefulness has been found to produce lapses in behavioral functioning that are comparable to alcohol intoxication.

One study found that after 22 hours of sustained wakefulness, participants’ performance on tests such as reaction time, reasoning ability, and task accuracy were comparable to performance with a blood alcohol content of 0.08% (Figure 2).2

Authors concluded that the study results suggested that “moderate levels of fatigue produce performance equivalent to or greater than those observed at levels of alcohol intoxication deemed unacceptable when driving, working and/or operating dangerous equipment”.2

Figure 2. Prolonged wakefulness compared to alcohol use: effects on alertness2
sustained wakefulness vs alcohol use

3. Sleep deprivation and reaction time

Research has demonstrated that reaction time slows following sleep deprivation.3

In one study, subjects were tested on their reaction time to a visual cue. Reaction time is not only slower following sleep deprivation, but as time on task increases, reaction time deteriorates at a steeper rate following sleep deprivation than following adequate sleep (Figure 3).3

 Figure 3. Sleep deprivation and reaction time3
sleep deprivation and reaction time

4. Shiftwork adaptation & fatigue

A person’s “circadian profile” tends to affect his or her ability to adapt to shiftwork. Three main characteristics of circadian profiles have been extensively evaluated: morningness/eveningness, flexibility of sleeping habits, and one’s ability to overcome drowsiness. Both flexibility of sleep habits and ability to overcome drowsiness are associated with better long term adaptation to shiftwork.4

According to CIRCADIAN’s shiftwork database, non-adapted workers report feeling drowsy and nodding off while working 3x more often than adapted workers and also reported making mistakes 4x more frequently than adapted workers (Figure 4).4

Figure 4. Shiftwork Adaptation & Feelings of Fatigue4
fatigue accidents and shiftwork adaptation

5. Fatigue & lost work time

Based on results from the Health & Work Performance Questionnaire (HPQ) – sleep disorders, depression, and fatigue are the three biggest contributors to lost work time (Figure 5).5 The HPQ is an employee self-report tool that assesses 29 chronic health conditions and includes questions related to accidents, injuries, and work performance.

Lost work time in this study included both absenteeism and presenteeism – which is defined as time spent at work focusing on non-work-related tasks. Results from this cross-sectional survey of health and productivity are based on 1,147 U.S. Department of Energy (DOE) employees at two DOE national laboratories.

Figure 5. Lost Work Time from Chronic Health Conditions5
lost work time fatigue insomnia sleep deprivation

Is fatigue impacting your workforce?

It can be challenging to determine if fatigue is negatively impacting your workforce. Some tell-tale signs of worker fatigue issues can include:

  • High worker’s compensation costs
  • High rates of errors and accidents
  • Sluggish employees
  • Heavy caffeine/nicotine consumption among workers
  • Lowered productivity
  • Increased absenteeism rates (especially unexpected absenteeism)

To learn more about fatigue and its impact on 24/7 operations, download our FREE white paper:

The Myths & Realities of Fatigue

Reducing the Costs, Risks, and Liabilities of Fatigue in 24-Hour Operations
myths and realities of worker fatigue
download white paper now

CIRCADIAN® FRMS and 24/7 Workforce Solutions

CIRCADIAN® is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock. Through a unique combination of consulting expertise, research and technology, software tools and informative publications, CIRCADIAN helps organizations in the 24-hour economy optimize employee performance and reduce the inherent risks and costs of their extended hours operations.

Fatigue risk management systems and solutions

tired businessman daylight savings
The beginning of Daylight Savings Time has left many of us feeling a bit fatigued. The 6:30 AM alarm instead feels like a 5:30 AM alarm, and even after a few days, lingering fatigue still seems to exist.

Why is it so difficult to adjust to the time change?

Our internal 24-hour clock – known as our circadian rhythm – doesn’t adjust to daylight savings time – even in the weeks following the time change.1 While the 1-hour time change seems minor, the repercussions of this change are dramatic.

Various studies have found that the beginning of daylight savings time is associated with:

  • Increased risk of heart attack 2
  • Increased rate of traffic accidents 3
  • Greater risk of workplace injuries 4
  • Reduced workplace productivity 5

The beginning of daylight savings time reminds us that our circadian rhythms are heavily dependent on our sleep and wakefulness schedules to regulate our alertness, immune response, activity levels, and hormone secretion patterns – along with many other functions.

Shifting Perspectives

Imagine if you had to make drastic changes to your sleep schedule every week. This is the reality of millions of shift workers, athletes, and traveling professionals – many of whom are left with feelings of chronic fatigue due these schedule shifts.

Erratic sleep schedules not only result in fatigue – but can lead to metabolic disturbances and other major health problems. While travel sometimes necessitates dramatic, abrupt changes in our circadian rhythm, shift work doesn’t.

Twenty-four hour operations can implement schedules that better complement circadian physiology – based on the rotational direction of schedules, speed of rotation, and pattern of rotation. To learn more about this – download our FREE white paper on biocompatible shift scheduling.

Biocompatible Shift Scheduling
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About CIRCADIAN

CIRCADIAN® is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock. Through a unique combination of consulting expertise, research and technology, software tools and informative publications, CIRCADIAN helps organizations with traditional and/or extended operating hours optimize employee performance and reduce the inherent risks and costs of sleep deprivation and fatigue.



REFERENCES

1. Kantermann, T., Juda, M., Merrow, M., & Roenneberg, T. (2007). The human circadian clock's seasonal adjustment is disrupted by daylight saving time. Current Biology, 17(22), 1996-2000.

2. Janszky, I., & Ljung, R. (2008). Shifts to and from daylight saving time and incidence of myocardial infarction. New England Journal of Medicine, 359(18), 1966-1968.

3. Varughese, J., & Allen, R. P. (2001). Fatal accidents following changes in daylight savings time: the American experience. Sleep medicine, 2(1), 31-36.

4. Christopher M. Barnes, David T. Wagner. Changing to daylight saving time cuts into sleep and increases workplace injuries. Journal of Applied Psychology, 2009; 94 (5): 1305 DOI: 10.1037/a0015320

5. Wagner, D. T., Barnes, C. M., Lim, V. K., & Ferris, D. L. (2012). Lost sleep and cyberloafing: Evidence from the laboratory and a daylight saving time quasi-experiment. Journal of Applied Psychology, 97(5), 1068.

 

Thursday, 19 February 2015 22:17

3 Reasons to Address Worker Fatigue ASAP

tired worker - male - daytime
Worker fatigue may be an issue in your operation – whether you're aware of it or not.
One-third of workforce managers believe that fatigue is a moderate or severe problem among their workers.1
To some, fatigue might seem like a minor concern, yet it costs companies millions of dollars each year in excess costs, accidents and errors.
Here are three reasons to immediately address worker fatigue in your operation:
  1. Fatigued workers cost employers $136.4 billion annually in health-related lost productive time (absenteeism and presenteeism), almost 4x more costly than their non-fatigued counterparts.2
  2. Fatigued workers exhibit up to 4x the worker’s compensation costs as compared to non-fatigued workers (Figure 1).3Workers Compensation  Fatigue
  3. Studies have found that severe stress and fatigue problems reduce worker productivity by up to 10% (Figure 2).3

The Take-away

People don’t release smoke, grind gears, or have pieces fall off; but their equivalents – fatigue, error, injury, and ill health – do result in failure and breakdown."  - Dr. Martin Moore-Ede, The Twenty-Four-Hour Society


The Solution

Reduce the costs, risks, and liabilities of fatigue within your 24/7 operation by implementing a customized shift scheduling system that accounts for:

  • business goals

  • operational constraints

  • employee preferences

  • ergonomic (physiological and sociological) criteria

A one-size-fits-all solution to the challenges of 24/7 operations simply does not exist.

The "ideal" solution depends on many factors including the makeup of one's workforce (employee demographics), the nature of the work, local customs and culture, commuting issues, type of industry, corporate policies, state and federal laws, and much more.

FREE White Paper – Biocompatible Shift Scheduling

Download our FREE white paper, "Biocompatible Shift Scheduling", to learn from CIRCADIAN experts about the key components of best shift scheduling practices. Topics covered include:

  • Number of consecutive work days
  • Duration of shifts
  • Start/end of shift times
  • Fixed vs rotating schedules
  • Speed of rotation

WP-Biocompatible-Shift-SchedulingdownloadAbout CIRCADIAN

CIRCADIAN® is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock.  Through a unique combination of consulting expertise, research and technology, software tools and informative publications, CIRCADIAN helps organizations with traditional and/or extended operating hours optimize employee performance and reduce the inherent risks and costs of sleep deprivation and fatigue.

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References

  1. CIRCADIAN (2007). Shiftwork Practices 2007.
  2. Ricci, J. A., Chee, E., Lorandeau, A. L., & Berger, J. (2007). Fatigue in the US workforce: prevalence and implications for lost productive work time. Journal of Occupational and Environmental Medicine, 49(1), 1-10.
  3. CIRCADIAN (2005). Shiftwork Practices 2005.



Friday, 19 December 2014 17:02

Top 10 Shift Work Myths

Myth #1 – Overtime within your workforce is evenly distributed

Best practices suggest that when overtime is equally distributed across a workforce, up to approximately 12% overtime is an acceptable rate. However, overtime rates vary across industries, companies and employees.

Research indicates that in many industries, 20% of employees work 60% or more of the overtime (Figure 4).1

Figure 4. Actual distribution of overtime at an extended hours facility.1Overtime distribution

Since accidents and safety problems can be caused by one fatigued employee, the risk of an accident occurring can rise as the distribution of overtime becomes increasingly skewed.

The imbalance exposes the pool of high overtime employees to extra health risks, and exposes the company to increased absenteeism costs, health care costs, safety issues, and legal liability.

Myth #2 – Employee productivity increases linearly

Studies and reports suggest that productivity can suffer with increased overtime hours.

Data from 18 manufacturing industries in the U.S. shows that for most of these industries, productivity (measured as output per hour) declines when overtime is used.2

On average, a 10% increase in overtime results in a 2.4% decrease in productivity (more output is achieved, but the number of hours worked increases as well—not as much output per hour is realized).

This performance decline is confirmed by the work of J. Nevison of Oak Associates. In his white paper, Nevison brings together scientific, business, and government data to demonstrate that little productive work takes place over and above 50 hours per week (Figure 2)3. Two other studies, also examined in the white paper, show that productive hours drop by an additional 10 hours when the number of consecutive long workweeks increases from four to 12, highlighting the cumulative effects that overtime can have on productivity.

Figure 2. Productive vs. actual work hours, from a collection of four studies4
overtime and productivity

Myth #3 – Adequate staffing means having enough employees to cover permanent positions

Often overlooked are the real drivers of overtime in 24/7 operations. In any given week, employees may not be available to fill their scheduled shifts because of multiple reasons including:

  • Vacation days
  • Floating holidays
  • Sickness related absenteeism
  • Non-sickness related absenteeism/personal days
  • Injury-related absenteeism
  • Training
  • Special work assignments (committees, team building, projects, etc.)
  • Jury duty, bereavement, FMLA, etc.
  • Turnover/delays in filling position with adequately trained employees

Many 24/7 operations do not realistically estimate or measure the full impact of these factors and hence run their shifts with fewer staff than needed, effectively increasing the relief coverage requirement (i.e. overtime) and impacting the time on duty and off duty of their personnel.

Furthermore, many companies do not monitor and analyze their historical payroll and human resources data so that they are unable to make even simple forecasts about scheduled and unscheduled absenteeism. Without this data, they are unable to accurately define seasonal, weekly and daily fluctuations in coverage demand.

Based on CIRCADIAN's 2014 Shiftwork Practices data, we found that the "leaner" operations (i.e. reduced staffing levels) reported higher absenteeism rates (Figure 1).

Interestingly, over 50% of all unscheduled absences are due to either: personal needs, stress, or an entitlement mentality (i.e. “I’ve earned it”).5

Figure 1. Staffing Levels & Absenteeism Rate 5absenteeism and staffing levels

Myth #4 – Operational decisions on shift scheduling are best if mandated by management.

Management-mandated work schedules often prevent an operation from reaching its full potential in terms of operational costs, productivity, efficiency, and safety.

Employee participation is just as important in the process of designing and implementing the new work schedule as the characteristics of the new work schedule itself.6-9

Surveys suggest that management-mandated work schedules can lead to:10

  • Increased absenteeism
  • Excessive overtime costs
  • Increased health problems and fatigue
  • Decreased morale
  • Increased turnover costs
  • Recruitment problems

Studies comparing methods of shift schedule selection have found that employee involvement in schedule redesign increases the benefits of schedule redesign considerably, as compared to management-mandated schedule changes. These benefits include:11-18

  • Increased worker satisfaction with schedule design
  • Decreased unscheduled absences from illness
  • Improved physical and psychological vigor
  • Decreased turnover and number of vacant positions
  • Increased organizational commitment
  • Improved employee and management relations

Myth #5 – If a shift schedule works well at our other plant, it will work for us here.

This is a common misconception in companies with multiple facility locations. A shift schedule that’s effective and well-liked at one facility can cause disagreements and tension among workers at a seemingly identical facility.

Shift schedules need to be based on the social, operational and physiological needs of the workforce and managers at each specific company site. Some factors to consider include:

  • Geographic location
  • The lifestyles of workers
  • Cultural differences
  • Worker demographics

These factors can greatly impact the popularity of different shift schedules among workers. For example, avoiding rush hour traffic is often important to workers in large cities, whereas workers in rural areas might prefer longer spans of days off.

Best shift scheduling practices suggest choosing a schedule with features that support the priorities of workers at each individual facility.

Pleasing everyone may be impossible, but having the majority of workers in favor of a new shift schedule will greatly increase the likelihood of a successful schedule change.

Myth #6 – Given the choice, workers always select the best schedule for them and the worst for the company.

Much conflict between management and shiftworkers is the result of misunderstanding and poor communication.

Management often feels that it is doing its part by “telling,” rather than both telling and listening to the needs of workers. Workers may feel that they’re providing valuable insight, but management only hears the complaints. As a result, management may feel that workers only care about themselves and making money.

While the occasional worker may try to game the system, most workers are truly concerned with the well-being of the company. After all, workers realize that any problem that the company faces will ultimately affect them. In light of this, most workers will choose a schedule that will satisfy the company while still fulfilling their individual needs.

The best way to ensure that workers understand the reasons for making any scheduling changes is by keeping them informed. This can be accomplished through company-wide meetings or events, as well as through regular emails or letters about the general state of the company.

Myth #7 – Falling asleep on the job is a matter of willpower

While curling up with a pillow and blanket at work is clearly deliberate, many fatigued individuals unknowingly experience microsleeps while working. A microsleep is a brief sleep episode that lasts up to 30 seconds, during which a person temporarily loses consciousness and external stimuli aren’t perceived.19

Individuals who experience microsleeps are often unaware that they briefly lost consciousness and will frequently deny that they fell asleep.20 When an individual arouses from a microsleep episode, it may feel like a brief lapse in attention or mind wandering.

Research suggests that even individual neurons can experience microsleeps, which means that your parts of the brain may be “offline” even if you’re seemingly awake.21

Microsleeps are most commonly associated with sleep deprivation and driving; however, microsleeps can also occur in the absence of sleep deprivation when completing monotonous, repetitive tasks.

Myth #8 – Napping during work is a lazy and unacceptable behavior

Before you write off napping as a leisurely activity that should be banned at work, you might want to consider the ways in which napping at your workplace can improve the alertness and productivity of workers.

Ten minute power naps provide immediate benefits upon awakening and boosts in performance that can last up to 4 hours!

Ten minute naps have been shown to: decrease fatigue, increase vigor, improve performance, improve communication, decrease blood pressure, improve reaction time, improve subject well-being, and increase alertness.

Longer naps that last 90 minutes (or longer) still offer many restorative benefits; however, they are not as efficient as power naps. Longer naps allow for memory consolidation and therefore have been shown to improve memory. Extended napping is frequently associated with profound sleep inertia, which can be crippling to productivity. In order to avoid the sleep inertia of long naps, it's advised to sleep a full 90 min sleep cycle in order to wake up at the lightest sleep stage.

Myth # 9 – Hours of service requirements are sufficient for mitigating employee fatigue

Most fatigue regulations start and end with hours of service policies. While this is a good starting place, it fails to address all of the factors that contribute to fatigue. To ensure the alertness of workers, a comprehensive fatigue risk management system (FRMS) needs to be in place.

CIRCADIAN® 5 Defenses FRMS Design

Fatigue risk management system

A fatigue risk management system (FRMS) is a data-driven, risk-informed, safety performance-based program that reduces the risk of fatigue-related incidents in 24/7 operations. An FRMS will continually monitor and reduce fatigue risk.

Workforces that have implemented fatigue risk management systems experience fewer problems with absenteeism, turnover and excessive overtime. Employees in these workforces have greater morale, less stress, and are more productive workers.

Myth #10 – There’s very little financial ROI with fatigue risk management

To some, fatigue might seem like a minor concern, yet it costs companies millions of dollars each year in excess costs, accidents and errors.

Fatigued workers cost employers $136.4 billion annually in health-related lost productive time (absenteeism and presenteeism), almost 4x more than their non-fatigued counterparts.22

Fatigued workers exhibit up to 4x the worker’s compensation costs as compared to non-fatigued workers (Figure 3).24 A recent meta-analysis of 27 observational studies found that sleep problems increase the risk of workplace injuries by 62 percent.23

Figure 3. Fatigue Levels & Worker’s Compensation24

fatigue and worker compensation Addressing and mitigating fatigue within an operation can significantly decrease excess costs related to: absenteeism, turnover, accidents, and healthcare.

fatigue risk management system savings

 

Debunk Other Shift Work Myths

Explore the variety of CIRCADIAN white papers that cover an assortment of 24/7 workforce topics including:

  • Shift Scheduling
  • Staffing Levels
  • Fatigue Risk Management Systems
  • Shiftwork Lifestyle Training
  • And much more!

white papers

 






REFERENCES

  1. CIRCADIAN databases
  2. Shepard E, Clifton T. Are Long Hours Reducing Productivity in Manufacturing. International Journal of Manpower 2000; 7.
  3. Nevison, J. Overtime Hours: The Rule of Fifty
  4. Permission from Nevison, Oak Associates.
  5. CIRCADIAN. 2014 Shiftwork Practices.
  6. Hauburger. Implementation of self-scheduling in the poison center. Vet. Hum. Toxicol. 39(3),175-7. 1997.
  7. Knauth P.The design of shift systems. Ergonomics 36(1-3),15-28. 1993.
  8. Knauth P. Changing schedules: shiftwork. Chronobiol. Int. 14(2),159-71. 1997.
  9. Kogi K, Di Martino VG. Trends in participatory process of changing shiftwork arrangements. Work & Stress 9 (2/3), 298-304. 1995.
  10. Circadian Technologies, Shiftwork Practices Survey 2002.
  11. Ala-Mursula et al. Employee control over working times: associations with subjective health and sickness absences. J. Epidemiol. Community Health 56(4),272-8. 2002.
  12. Beltzhoover M. Self-scheduling: an innovative approach. Nurs. Manage. 25(4),81-2. 1994.
  13. Bradley, Martin. Continuous personnel scheduling algorithms: a literature review. J. Soc. Health Syst. 2(2),8-23. 1991.
  14. Holtom et al. The relationship between work status congruence and work-related attitudes and behaviors. J. Appl. Psychol. 87(5),903-15. 2002.
  15. Moore-Ede M. The Twenty-Four Hour Society: Understanding Human Limits in a World that Never Sleeps. 1994.
  16. Smith PA et al. Change from slowly rotating 8-hour shifts to rapidly rotating 8-hour and 12-hour shifts using participative shift roster design. Scand. J. Work Environ. Health. 24(S3), 55-61. 1998.
  17. Teahan. Implementation of a self-scheduling system: a solution to more than just schedules! J. Nurs. Manag. 6(6),361- 81. 998. Erratum in: J. Nurs. Manag. 7(1),65. 1999.
  18. Sakai K et al. Educational and intervention strategies for improving a shift system: an experience in a disabled persons' facility. Ergonomics 36(1-3),219-25. 1993.
  19. International Classification of Sleep Disorders Diagnostic and Coding Manual, http://www.esst.org/adds/ICSD.pdf, page 343.
  20. Higgins, Laura; Fette Bernie (in press). "Drowsy Driving" (PDF). Retrieved 2013-06-12.
  21. Vyazovskiy, V. V., Olcese, U., Hanlon, E. C., Nir, Y., Cirelli, C., & Tononi, G. (2011). Local sleep in awake rats. Nature, 472(7344), 443-447.
  22. Ricci, J. A., Chee, E., Lorandeau, A. L., & Berger, J. (2007). Fatigue in the US workforce: prevalence and implications for lost productive work time. Journal of Occupational and Environmental Medicine, 49(1), 1-10.
  23. Katrin Uehli, Amar J. Mehta, David Miedinger, Kerstin Hug, Christian Schindler, Edith Holsboer-Trachsler, Jörg D. Leuppi, et al. (2014). Sleep problems and work injuries: A systematic review and meta-analysis. Sleep Medicine Reviews. doi:10.1016/j.smrv.2013.01.004
  24. Aguirre, A. Shiftwork Practices Survey, 2005.

alt
In September, the American Nurses Association released a position statement regarding nurse fatigue. According to the ANA, both registered nurses and employers have a joint responsibility to “reduce risks from nurse fatigue and to create and sustain a culture of safety, a healthy work environment, and a work-life balance.”

The ANA also stated that "registered nurses and employers have an ethical responsibility to carefully consider the need for adequate rest and sleep when deciding whether to offer or accept work assignments, including on-call, voluntary, or mandatory overtime.”

Here are five reasons why you should prioritize nurse fatigue management:

1. The Prevalence of Fatigue Among Nurses

An abundance of research data on nursing fatigue exists to support the conclusion that fatigue is a serious concern for the healthcare industry.

Compared to the 7-8 hours of sleep required for optimal alertness and performance, it’s sobering that 80% of nurses get less than 6 hours of sleep prior to working a shift and 55% of nurses report that they “almost always” or “all of the time” felt fatigued during work (Scott et al., 2007; Geiger-Brown et al., 2012; Canadian Nurses Association & Registered Nurses Association, 2010).

2. High Injury Rates Among Healthcare Workers

According to the Occupational Safety & Health Association (OSHA), the healthcare and social assistance industry reported more injury and illness cases than any other private industry sector in 2011.

Fatigued workers exhibit up to 4x the workers compensation costs of non-fatigued workers, as shown in Figure 1 (CIRCADIAN, 2005).

Between 2006 and 2011, the average workers’ compensation claim for a hospital injury was found to be $15,860 among the roughly 1,000 hospitals surveyed (Aon Risk Solutions, 2012).

Figure 1. Workers Compensation Claims & Fatigue Levels
workers compensation and worker fatigue

3. High Turnover Rates & United States Nursing Shortage

There is a nursing shortages as a significant segment of the nursing workforce is nearing retirement. Experts project that more than 1 million nurses will reach retirement age in the next 10 to 15 years. This poses a major concern for members of the healthcare industry, as nursing school enrollment rates have been on a steady decline. Because of these factors, it’s become increasingly important for healthcare systems to retain nurses.

It’s no secret that high turnover rates are having serious implications on the healthcare industry, as a national survey of home healthcare agencies reported a 21% turnover rate for registered nurses (Hospital and Healthcare Compensation Services, 2000).

Interestingly, turnover rates are found to be significantly higher in workforces experiencing employee fatigue and stress problems, as seen in Figure 2 (CIRCADIAN, 2005).

Figure 2. Association between Turnover Rates and Fatigue and Stress Levels

employee turnover fatigue and stress

Replacing a nurse’s position has been estimated to cost an employer between $27,000 and $103,000 (Li & Jones, 2012). Given the high cost, fatigue risk management can be a cost-effective approach for reducing the high turnover rate among nurses.

4. Overtime & Workplace Injuries

Research looking at 110,326 U.S. job records revealed that working in jobs with overtime schedules was associated with a 61% higher injury hazard rate as compared to jobs without overtime. Working at least 12 hours per day was associated with a 37% higher injury hazard rate and working at least 60 hours per week was associated with a 23% increased hazard rate (Dembe, Erickson, & Banks, 2005).

These findings may not even account for all workplace injuries. One study found that 24% of nurses and nursing assistants changed shifts or took sick leave to recover from an unreported injury (Siddharthan, Hodgson, Rosenberg, Haiduven, & Nelson, 2006).

5. Joint Commission Statement on Fatigue

In December 2011, the Joint Commission, which accredits more than 20,000 U.S. healthcare organizations, recommended that healthcare organizations “create and implement a fatigue management plan.”

According to the Joint Commission’s Sentinel Event Alert, Health Care Worker Fatigue and Patient Safety, “There are now some evidence-based actions that healthcare organizations can take to help mitigate the risk of fatigue that results from the extended work hours – and, therefore, protect patients from preventable adverse outcomes.”

Commitment to Care

The mission statement of most healthcare organizations highlights the organization’s commitment to excellence in providing health care, patient safety, and improving the well-being of their local community.

A commitment to excellence is only truly upheld when an organization employs all possible measures to ensure unsurpassed patient care and safety. This means addressing workforce problems that impact the individual care providers, as these issues can have a domino effect that negatively impacts the quality of patient care.

If your organization isn’t addressing and managing the fatigue of the care providers, then scientific research suggests that your organization will suffer lapses in its commitment to superior patient care.

Solutions for Nurse Fatigue

To learn more about solutions for addressing, mitigating and managing nurse fatigue, download our white paper titled “Fatigued Nurses: Assessing the Risk, Implementing the Defenses

Nurse Fatigue White Paperalt
About CIRCADIAN®

CIRCADIAN® is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock. Through a unique combination of consulting expertise, research, software tools and informative publications, CIRCADIAN helps organizations in 24/7 workforces optimize employee performance and reduce the inherent risks and costs of their extended hours operations.

REFERENCES

Aon Risk Solutions (2012). Health Care Workers Compensation Barometer.

Canadian Nurses Association & Registered Nurses’ Association of Ontario (2010): Nurse fatigue and patient safety research report. http://www.arnpei.ca/images/documents/ Fatigue_Safety_2010_EX%20Summary_e.pdf (retrieved February 22, 2013).

CIRCADIAN (2004). Shiftwork Practices 2004.

CIRCADIAN (2005). Shiftwork Practices 2005.

CIRCADIAN (2007). Shiftwork Practices 2007.

CIRCADIAN (2014). Shiftwork Practices 2014.

Geiger-Brown J et al. (2012): Sleep, sleepiness, fatigue, and performance of 12-hour-shift nurses. Chronobiology International 29(2): 211-219.

Hospital and Healthcare Compensation Services, Homecare Salary & Benefits Report, 2000-2001. Oakland, NJ: Hospital & Healthcare Compensation Service, 2000.

The Joint Commission (2011). Health care worker fatigue and patient safety. Sentinel Event Alert. 48.

Li , Y., & Jones, C.B. (2012). A literature review of nursing turnover costs. Journal of Nursing Management. 21(3): 405-418. (Dollar amounts presented here are adjusted to 2013 prices.

Siddharthan, K., Hodgson M., Rosenberg D., Haiduven D., and Nelson, A. (2006). Under-reporting of work-related musculoskeletal disorders in the Veterans Administration. International Journal of Health Care Quality Assurance. 19(6): 463-476

 





 

Wednesday, 10 December 2014 18:21

Fatigue in the Control Room: The Unique Dangers

Why is fatigue mitigation critical for control room operators?

Control room operators across various industries are responsible for monitoring and maintaining systems that can that influence the safety of a workforce.

They are required to be attentive for extended periods of time, detect subtle changes in systems, respond quickly to safety threats and other incidents, and maintain communication with various workforce crews – just to name a few job responsibilities.

Based on the known switches of human alertness, the nature of the control room environment and complex job requirements can increase the likelihood of a fatigued operator falling asleep on the job.

Clearly, this could have devastating consequences – which validates the need for federal regulations on maximum hours of service, employee fatigue training, and workload assessment for control room operations.

Yet how does a fatigued control room operator threaten the integrity and safety of an operation beyond lapses in attention due to fatigue?

Imagine this scenario…

A control room operator shows up for the night shift feeling fatigued. In a sleep-deprived state, the operator struggles to remain alert and attentive to the many computer monitors reporting back that things are running smoothly. The calming hum of the computers acts as a lullaby to the fatigued operator, who can’t help but to feel sleepy in the dimly-lit control room. It’s almost as if the room was designed to put the operator to sleep.

control room
The sleep-deprived operator is having trouble with maintaining focus on relevant cues, developing and updating strategies based on new information, keeping track of events, and attending to activities judged to be non-essential.

The operator eventually falls into a state known as “automatic behavior syndrome”, in which he or she looks to be attentive and responsive, but is unable to respond to changes in the system or maintain situational awareness.

Out of nowhere, a situation arises. A pipeline is under abnormally high pressure after the operator fails to respond to a pressure change in one of the gauges. The operator switches into high-alert mode, but the cognitive declines associated with fatigue linger.

The fatigued operator is slow to assess the situation and struggles to draw upon previous training to develop a solution. The operator makes a unilateral decision to proceed with a risky strategy for fixing the pipeline. The crew cautions the operator that safer, more effective options exist; however, the operator chooses to continue with the risky strategy.

In a distressed and cognitive impaired state, the operator fails to communicate several key details to crews trying to fix the problem. The pipeline ruptures, resulting in devastating damage to the environment and costly fines to the company.

 ruptured pipeline

This is reality of worker fatigue.

This hypothetical scenario has been an unfortunate reality in too many situations.

In fact, worker fatigue was found to be a contributing factor in the infamous 1986 Chernobyl disaster, where disastrous decisions were made by control room operators working long night shifts.

alt

Fatigue-related error was deemed a contributing factor to the 1986 Chernobyl Disaster. (Image from boston.com)

Disasters like Chernobyl, Three-Mile Island, and the 2005 Texas City Explosion are solemn reminders that fatigued control room operators can inadvertently make poor decisions that can have grave consequences.

For these reasons, it makes perfect sense as to why fatigue management should be a priority for operators, facility managers, and all 24/7 industries.

Most fatigue regulations start and end with hours of service policies. While this is a good starting place, it fails to address all of the factors that contribute to fatigue, such as control room design. To ensure the alertness of workers, a comprehensive fatigue risk management system (FRMS) needs to be in place.

CIRCADIAN® 5 Defenses FRMS Design
CIRCADIAN 5 Defenses FRMS

Learn more about Fatigue Risk Management Systems

Download our white paper, “Evolution of Fatigue Risk Management Systems”, to learn more about the development of fatigue risk management systems and the CIRCADIAN® 5 Defenses FRMS Design.

Download our White Paper

 FRMS White Paper

download white paper

About CIRCADIAN®

CIRCADIAN® is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock.  Through a unique combination of consulting expertise, research, software tools and informative publications, CIRCADIAN helps organizations in 24/7 workforces optimize employee performance and reduce the inherent risks and costs of their extended hours operations.

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