How a holistic ergonomic approach can develop resilience in Home Care workers
Traditional approaches in ergonomics tends to a focus on the individual and their response to the physical arrangements of their work environment. For example the individuals posture, movement and reaction time in response to the object or environment they are working on or in. In contrast, holistic ergonomics considers not only these factors, but also the impact social arrangements that exist in the work environment have on the way the individual approaches their work. Not only in terms of physical movements and reaction but also their behaviours, language appearance and actions These arrangements, depending on how they are structured, can create an environment that is resilient to the stresses. The focus of this paper is to explore the influence of cultural factors in the context of Home Care work and what considerations need to be made, in terms of creating a resilient culture in that environment.
The health care and social assistance sector in Australia according to data provided by Safe Work Australia is the largest employer accounting for 13 % of employment. The purpose of the sector is to provide personal care, domestic and support to vulnerable persons in the community. With the recent changes occurring in the sector, which includes the introduction of the National Disability Insurance Scheme and an ageing population this growth is anticipated to continue. The profile of the sector is predominately female and a large proportion employed are between the ages of 45-55. In terms of injury profile, while fatalities are relatively low, the industry ranked 1st in terms of highest number of serious claims and 4th in terms of injury frequency rate in terms of 8.8 per million hours worked. In terms of injury mechanisms; muscular stress is the predominate mechanism followed by slips trips and falls, assault by persons and vehicle incidents.
This data is supported by Quinlan, Bohle, Rawlings (2015) who outlines the challenges faced by Home Care Workers that are a source of contribution to these injuries. They include
· Lack of control over hours worked. This includes casual shifts which can change daily depending on client availability and certain tasks being required to be accomplished within a set period not allowing for flexibility and alterations to the roster schedule. This can result in Home Care workers working under pressure to get the job done, particularly if the routine is suddenly disrupted due to factors such a clients deteriorating health and challenging family arrangements.
· Lack of control over the work environment. This can include working in environments and working with equipment in clients home that are either of inadequate space or not fit for purpose. The clients condition both physical and mental can also vary which can result in Home care workers suddenly having to manage challenging behaviours. Home Care workers can also be exposed to challenging and confronting behaviour from family members and other persons on site.
· Due to them working in remote locations, many Home Care Workers do not have the opportunity to participate in training or have easy access to their managers or peers for support. This can result in them having to make difficult decisions under pressure with very little training in how to manage such situations.
In terms of Home Care workers perceived social status in society, this is reflected in a news story of care worker Beth Sturges who wrote a response on social media to those who perceive who work as nothing more than “bottom wipers”. In her response she expresses pride in looking after and caring for the vulnerable in community despite the challenges such as dealing with emergencies or the death of clients. The perception of society to people who work in labour dominated industries is discussed by Radley (1991) In Chapter 2 “Subordination to a Democratic Eye”. In this Chapter he discusses the impact of the historical separation of work that involved specialization and decision making verses work conducted in the physical environment and the attempts by those to reduce power in the labour group, through restructuring it in a manner such as the division of tasks and introduction of repetitive work over long periods so to prevent people working in this area, to gain skills and expertise over the whole of work. The result is creating a subservient class of people dependent on others for the allocation and instruction of work. The other factor that Radley (1991) explored was the perception and the role of women and their work. Radley also outlined how as women’s bodies were perceived as perishable as a result of restricted time frames for child bearing and monthly bleeding they were consequently deemed unsuitable for participating in work that required strength and leadership. Consequently, women were traditionally assigned work that was in keeping with their carer status i.e looking after others and removed from work that required leadership and decision making.
The social impact on the individual working in labour organizations and their response is highlighted in a video series called dirty jobs. One video depicted labourer’s dismantling a home[i]. In the video it is observed one young man Travis fixing a dislocated shoulder while on the job while he continues working. This behaviour was explained by Radley (1991) in Chapter 5 where individuals working in labour jobs develop a sense of importance around their physical strength and physic in completing work. To the extent they would prefer too to keep on working despite having injuries, as a display of strength and to maintain their social standing within the group.
Similarly, for Home Care workers as illustrated by the Beth Sturges, Home Care Workers pride themselves on their capacity to care for and look after others, irrespective of the harm their work or environment may have on their health and well- being. From my observations from working in the industry, it is not unusual for Home Care workers to develop a very close relationships with the people they area caring for. It is not unusual for Home Care workers to under report incidents or hazards out of fear of losing the trust and relationships with that client.
The behaviours of Home Care Workers can be attributed to what is known as Personhood. This has been defined by Erde (1999) of the sense that individuals make of their world through relationships with others and in turn influencing the decisions, behaviour and actions they make in response to their social interaction with others. One of the important characteristics of Personhood is in the persons desire to fit in and be accepted by others. This can include wearing certain types of clothes or adopting certain postures or language. At a collective level this language, clothing and postures can become part of the culture of the group, or “The way we do things around here”.
The influence of group think on social behaviour can be illustrated from example of the shearing industry presented by Michael Lawrence in the videos on Holistic Ergonomics. Michael provided an example of the social arrangements of two different shearing teams. One being a team that travelled together, the other being a team where the members went home every evening after work and had very little opportunity for socialization. Michael observed that there was more fights and disagreements in the second team than the first which he attributed to members not being able to form social relations and form a common understanding between themselves, in terms of language and behaviour. Particularly in response to dealing with the work stresses in the environment.
In applying the same approach to Home Care Workers, there is an identified requirement for Home Care Workers to develop strong social relationships with their work team. as much as it is with their clients. Particularly if the organization is committed to reducing the impact of injuries and develop a resilient organization whose people are able to effectively respond and manage some of the day to day challenging issues in the environment, with minimal impact to their health and well- being.
The first consideration is to focus on creating an environment for Home Care Workers that provides them with a sense of belonging. Unlike other environments most Home Care Workers work remotely with very opportunity to socialize or connect with others on a daily basis. Part of the consideration in setting up a strong social environment is the need for peer or buddy support that individual workers are able to tap into. This can include both a fellow worker or an identified experienced mentor within the team who is able to provide input and assistance both by phone contact and direct contact in that environment. Another consideration is the relationship between the individual worker and the organization as a whole. If there is a perceived disconnect between Senior Management and the workforce, while the worker and the group may have developed an agreed set of values it may contradict with the values set by Senior Management , which in turn can lead to disenchantment with the organization and a reluctance to support the organization values. Therefore emphasis on Senior Management “ walking the floor” and having discussions with the workers, are imperative in order for both groups to connect and obtain a mutual sense of understanding between each other of how the values and objectives of the organization are to be implemented within the workforce
The second consideration is how to develop an environment that encourages both learning and contribution. In some organizations the Home Care workers are arranged in teams which are usually based on the geographical location where the Home Care Worker works. Part of that team arrangement should include a regular meeting where the Home Care Workers have the opportunity to come together to discuss work issues and solutions. In order to encourage participation and contribution for staff, it is important that the meeting are structured in a facilitation style, where either a Care Worker has the opportunity to lead whole or part of the meeting, or has the opportunity to learn, reflect and contribute to the issues discussed and their solutions.
In terms of the organization approach to managing risks around complex issues such as manual handling and mental stress, a holistic approach must be taken as part of the investigation into the incidents. This not only involves investigating causes in the physical environment such as equipment or layout of the environment, but also the social arrangements that may exist in the environment between the Home Care Worker and clients and the individual e.g Home Care worker rushing the service due to client demands and their team environment,e.g perceived lack of support or team disruption, that can also contribute to the injuries. Other factors to consider is also the ability for the Care Workers to adjust their service or tasks to minimize factors such as repetitive work and environment demands or changes in the physical and mental state of their clients.
The final consideration is in relation to capacity building and retention of the workforce. In an industry that has a high turn- over of the workforce, loss of intellectual knowledge and destabilization of the workforce are threats to sustaining a resilient organization. While it can be challenging to manage workers, who have long term injuries in a labour intensive environment. Considerations in investing in fitness and wellness programs for the workforce, to enable them to maintain their physical fitness is a strategy worth exploring. Also tailoring training to be task specific, enables Home Care Workers to build specific techniques and skills in the challenging areas
In conclusion this paper identified the challenging environment of Home Care work and the nature of injuries arising from the work environment. In identifying the injuries, a holistic ergonomic approach was taken in not just exploring the physical environment but the impact social arrangements between the person and others had on the persons behaviour and actions in responses to managing these stressors. The paper concludes by listing strategies to be adopted to minimize the negative impacts that can arise from the social arrangements. It is anticipated that through the adoption of such strategies it will enable organisations to be better equipped to manage the risks and challenges associated with Home Care work.
 Priority Industry Snapshot. Home Care and Social Services; Safe Work Australia . June 2018
 Quinlan Michael, Bohle Phillip, Rowlings Olivia (2015) Health and Safety of Home Care Workers engaged by temporary employment agencies. Journal of Industraial Relations (2015),57(1) 94-114
 www.news.com.au/lifestyle/health/health-problems/woman-pens-a-heartwarming-letter-to-those-who-look-down-on-care-workers/news-story/a67186f8ed5d9f3f6152a24773f51218#.inm Nicola Stow, The Sun August 19 20018
 Radley Alan (1991) Chapter 2 Subordination to a Democratic Eye. The Body of Social Psychology . Springer- Verlag New Yok.
 Dirty Jobs Dismantling a Home https://www.youtube.com/watch?time_continue=31&v=a1LlCn8WouI
 Radley Alan (1991) Chapter 5 The embodiment of group relationships. The Body of Social Psychology . Springer- Verlag New Yok.
 Erde Edmond (1999) Chapter 6 Personhood in Personhood and Health Care David C. Thomas;David N. Weisstub;Christian Hervé (1999) Springer, Dordrecht