Corporate initiatives in ergonomics—an introduction

Applied Ergonomics 34 (2003) 3–15 Corporate initiatives in ergonomics—an introduction . Goran M. H.agg* Programme for Ergonomics, National Institute for Working Life, SE-112 79 Stockholm, Sweden Abstract Examples in the literature of corporate initiatives in ergonomics are reviewed. Different types of programmes are identified with ambitions ranging from time-limited interventions to continuous processes. Common elements are health surveillance, workstation design and choice of tools, product design, quality aspects, participative aspects and education, training and information. The implementation of ergonomics programmes varies substantially depending on the type of company, and company policies and organisation. Some of the most developed ergonomics programmes originate from the automobile industry. Other businesses with many established programmes are the electronics industry, the food industry and the office environment. A participative approach, as well as ergonomics expertise, are crucial ingredients for a successful programme. The scientific evaluation of ergonomics programmes, especially in economical terms, is in too many cases insufficient or missing. Furthermore, links to company core values such as quality improvement are often lacking. Programmes in ergonomics are still often seen as solely a matter of health and safety. Only a few companies have reached the state where ergonomics constitutes an integrated part of the overall strategy of the enterprise. r 2002 Elsevier Science Ltd. All rights reserved. Keywords: Intervention; Participation; Education; Training; Process 1. Introduction Ergonomics is a fairly new science with its roots in the late 1940s. Over the years the definition of ergonomics has gradually been broadened. Increasing research efforts have yielded a considerable body of knowledge concerning the design of tools and workstations, as well as organisational design to prevent worker discomfort, illness and absenteeism, and also to improve productivity and product quality. The dissemination of this knowledge to working life started early, but for many years these issues were considered mainly as ethical questions handled by the personnel department. The main promoters of ergonomics in industry have traditionally been national authorities such as OSHA in the USA and researchers in the field. During the 1990s the interest for ergonomic issues in a wide sense has grown within enterprises, as a result of an increasing awareness of the importance of these matters for corporate core values such as productivity, quality and an inevitable change process (Wilson, 1999). *Tel.: +46-8-7309314; fax: +46-8-7309246. E-mail address: [email protected] (G.M. H.agg). One consequence of this is that tailored ergonomic programmes are set up for whole companies or groups within companies, e.g. office workers, floor workshop personnel or designers of products. Such programmes may consist of guidelines concerning aspects of workload, such as work postures and movements, lifts, and also guidelines concerning equipment, product design, noise levels, vibration, lighting, climate, procedural information, safety and work organisation. The company staff is trained to apply good ergonomics to promote health, well being, productivity and product quality. The programme can be a stand-alone ergonomics programme or it can be integrated with other company policies. Numerous reports in the scientific literature describe such programmes more or less briefly. These reports often concern interventions made by researchers addressing some specific hypothesis. However, the programme documentation is often fragmentary, leaving out information on, e.g. degree of company involvement, long-term impact in the organisation or training efforts. This paper aims at a critical survey of such company programmes as an introduction to the following technical notes of the present special issue of Applied Ergonomics devoted to the theme ‘‘Corporate Initiatives 0003-6870/02/$ - see front matter r 2002 Elsevier Science Ltd. All rights reserved. PII: S 0 0 0 3 - 6 8 7 0 ( 0 2 ) 0 0 0 7 8 - 9 4 G.M. Hagg . / Applied Ergonomics 34 (2003) 3–15 in Ergonomics’’. Industrial programmes presented in major international ergonomics journals, conference proceedings and books, mainly over the last decade, have been sought. The inclusion criteria for reviewed programme presentations are that they mainly address physical factors in the workplace and that there is a documented serious involvement by the company. A list of the programmes reviewed in this paper is given in Table 1. 2. Types of initiatives Company programmes in ergonomics involve a wide range of measures depending on the type of enterprise, company policies and culture, and also national legislation and cultural traditions. They may be initiated by an authority citation (Adler et al., 1997), new legislation (Butler, 2003 this issue), increasing workers’ compensation claims or incidence of musculoskeletal disorders (MSD) (Halpern and Dawson, 1997) or demands for a better company image in society or combinations thereof. The initiative may come from the management (Gleaves and Mercurio, 1991; Halpern and Dawson, 1997; Smyth, 2003 this issue), an already existing department for ergonomics or health and safety (Stroud, 1999), external researchers (Axelsson, 2000b; Moore and Garg, 1998) or trade unions (Joseph, this issue). They can basically be characterised either as isolated timelimited actions to solve a specific problem or as continuous processes. 2.1. Time-limited actions A time-limited action addresses a specific problem at a certain time and hopefully solves the problem; however, it remains an isolated event which often has time-limited consequences in the fast changing working life of today. Many such interventions are initiated by researchers, often with the main purpose of verifying some hypothesis. However, if the addressed problem is acknowledged, and the solution is accepted and implemented by the company, the intervention may be beneficial for the company in addition to the scientific gain. In contrast to a process described below, a timelimited intervention usually permits before/after measurements, which is rewarding from scientific point of view. Hence, such interventions are likely to be generally overrepresented in scientific reporting of ergonomics measures in the field. For a review, see Westgaard and Winkel (1997). Another advantage of a time-limited intervention compared with continuous processes is that it is easier to evaluate from an economical point of view as an investment yielding a possible profit. For a survey of such measures, see Oxenburgh (1991). 2.2. Continuous processes Changes in modern enterprises are increasingly described as continuous processes. ‘Continuous improvements’ is a basic, originally Japanese concept, which has inspired large parts of the industrial world (Lillrank and Kano, 1989). In line with this, ergonomics programmes are set up as continuous processes, involving the whole enterprise or major parts of it (e.g. (Joseph, this issue; Smyth, 2003 this issue)). In the fast changing industrial world such an approach is inevitable in a longer perspective, since single interventions soon loose their relevance. At the start of a continuous ergonomics process the major activities are often of a reactive nature. If the programme is sound it will mature; it will gradually involve more proactive measures and become an integral part of the company’s policy (e.g. (Albin, 1999; Gleaves and Mercurio, 1991; Munck-Ulfsf.alt et al., 2003 this issue). 3. Elements of ergonomics programmes When examining corporate ergonomics initiatives, a number of basic elements may be discerned, as briefly described and exemplified below. 3.1. Workstation design and choice of tools There is a comparatively large amount of knowledge available regarding optimal design of workstations and tools, acceptable workloads and related risk factors. Even if definite limits still do not exist in many cases, there is a good basis for the identification of definitely adverse conditions (Hagberg et al., 1995). Hence, today it is meaningful to operationalise this knowledge into workplace assessment systems, e.g. by three-class gradings, green/yellow/red, where green stands for acceptable, yellow for possibly acceptable (further assessment needed) and red for unacceptable (e.g. NBOSH, 1998). Such classification systems and checklists have been tailored for different company needs and used at different kinds of audits, and also in the design process (Herring and Wick, 1998; Jimmerson, 1998; Moreau, 2003 this issue; Smyth, 2003 this issue; Svensson and . Sandstrom, 1995). The design of hand-held tools has lately improved considerably in terms of ergonomics. However, there are many (often cheaper) less suitable tools available on the market and the choice is not easy. Therefore, some companies have established special committees with representatives from the departments for engineering, purchasing, production and ergonomics to assess and test tools on the market (e.g. Munck-Ulfsf.alt et al., 2003 this issue). All purchased tools have to be approved by the committee. G.M. Hagg . / Applied Ergonomics 34 (2003) 3–15 5 Table 1 Reviewed programmes Type of business References Automotive industry Brandenburg and Bubser (1999) Klatte et al. (1997) Joseph (this issue)a Joseph and Long (1991) Jimmerson (1998) Kilduff (1998) Siffer and Jimmerson (2000) Moreau 2003 (This issue)a Munck-Ulfsf.alt et al. 2003 (This issue)a Oriet and Ewasyshyn (1998) Stroud (1999) . (1995) Svensson and Sandstrom . (1997) Svensson and Sandstrom Sugimoto et al. (1998) Beverage distribution Bugge and Berger (1994) Butler 2003 (This issue)a Cosmetics manufact. Smyth 2003 (This issue)a Electrical installation Niggebrugge and Schelle (1999) Electronics industry Aar(as (1999) Aar(as (1994) Chatterjee (1992) Helander and Burri (1995) Herring and Wick (1998) McKenzie et al. (1985) Hearing protection manufacturing Odenrick and Arvidsson (2000) Lighting manuf. Gleaves and Mercurio (1991) Basic contents Outcome/evaluation Comments Health surveillance. Health dpt. involved in audits, reactively as well as proactively Quality improvement through ergonomic workstation design Ergonomics process involving reactive and proactive measures. Training programme. Dissemination to plants in other countries Development and application of ergonomics assessment tools Health surveillance Ergonomics process involving reactive and proactive measures. Training of all personnel. Integral part of quality strategy Traditional ergonomics programme Ergonomics process involving reactive and proactive measures. Training programme Feedback of MSD per department with estimated costs Assessment model to match workstation design to worker capacity Change of manual handling routines and equipment in the distribution chain Reduced costs due to improved health No connection between health surveillance and quality programme Change of manual handling routines and equipment in the distribution chain Reduced number of worker compensation claims Reduced MSD incidence Increased ergonomics awareness on all levels ? Documentation sparse ? Reduced physical strain Improved working conditions according to questionnaire among distribution personnel Reduced costs due to decreased worker compensation claims. Profitable investments Reduced MSD incidence Training of engineers and operator representatives in all departments. Health surveillance with direct feedback to departments Information campaign on posters, ? brochures and mouse pads Workstation design Reduced MSD incidence Reduced costs due to reduced staff turnover, recruitment and sick leave. Profitable investments Improved tools and workReduced MSD incidence stations. Workforce training Extensive traditional ergonomic Reduced costs due to measures. Training of personnel. productivity increase, Information on videos and improved quality and brochures. Travelling exhibition injury reduction. Profitable investments Observation and checklist Reduced MSD incidence tools to identify adverse workstations Extensive traditional ergonomic Reduced MSD incidence measures. Training of engineers and supervisors Expert-supported participatory Several improvements change groups addressing regarding workstations workstation design and work and organisational design organisation ‘‘Ergonomic circles’’ at each Several workstation department responsible improvements. Generally for problem identification better team spirit and solving. Ergonomics training for all hourly workers Initiatives adopted by competitors Documentation sparse Four plant cases in detail G.M. Hagg . / Applied Ergonomics 34 (2003) 3–15 6 Table 1 (continued) Type of business References Basic contents Outcome/evaluation Office Aar(as (1999) Aar(as et al. (1998) Albin (1999) Albin et al. (1997) Improved lighting, furniture and individually adapted glasses Group training, furniture and equipment specifications. Self-help software. Office ergonomics clinic with advice to workers with problems Training programme for local ‘‘ergonomics expert’’ operators Reduced visual discomfort and pain Profitable investment in equipment due to reduced worker compensation claims. Change in company culture Reduced costs due to decreased worker compensation claims and lost time. Profitable investment Reduced MSD. Three case reports Increased knowledge and user control Baxter and Harrison (2000) Robertson et al. (2000) Ergonomics training for supervisors and workers. New office equipment ‘‘Video kiosk’’ information. Mock-up demonstrations Participatory process to improve workstations, tools and procedures Railway car repair Laitinen et al. (1998) Red meat industry Gjessing et al. (1994) Moore and Garg (1998) Participatory process to improve workstations, tools and procedures Smith (1994) Training of supervisors and employees in ergonomics. Employees as ergonomics coordinators. Employee focus groups Expert-supported change groups to improve workstations, tools and procedures Union/management human factors work group, providing information, audits and problem solutions Participatory self-assessment of working postures (RULA) Sewing Halpern and Dawson (1997) Telecommunications Baxter and Harrison (1998) Unspecified assembly Axelsson (2000a) work a Comments Reduced absenteeism. Less MSD incidence. Improved psychosocial climate Reduced costs due to decreased worker compensation claims and lost time. Mainly decreased MSD incidence Reduced costs due to decreased worker compensation claims Reduced MSD incidence Initially increasing MSD rates Improved quality and reduced MSD incidence In this issue. 3.2. Product design The design of a product is essential for the working conditions when producing it, influencing the load on the workers as well as production costs and quality outcome (Helander and Nagamichi, 1992). The more complex the work that has to be done on a product, the more important these aspects become. Hence, product design is addressed in many company programmes for ergonomics. This concept has been developed mainly in the automobile industry (e.g. Munck-Ulfsf.alt et al., 2003 . this issue; Svensson and Sandstrom, 1997). However, attempts have also been reported from the electromechanical industry (Broberg, 1997). Components delivered by subcontractors often cause ergonomic problems in assembly work. Hence, demands are also put on such components, e.g. fasteners (MunckUlfsf.alt et al., 2003 this issue). Furthermore, work is reported regarding the development of ergonomic guidelines for electrical connectors, intended for subcontractors. Mechanical properties are crucial for assembly strain, as well as for connection quality, and hence they become an issue of product quality (Siffer and Jimmerson, 2000). 3.3. Organisational design Work organisation is an important part of the modern broad ergonomics concept. In particular, the opportunities for job variation, rotation and enlargement are of great importance for the prevention of MSD. There is an extensive literature regarding industrial organisation, but there are few examples where organisational issues are addressed in conjunction with more traditional ergonomics issues. However, the Volvo Car Corporation (VCC) touches upon these issues in their programme presented in this issue (Munck-Ulfsf.alt et al., 2003 this issue). 3.4. Quality aspects Quality improvement of products and services has been a major incentive for the development of industrial production in the industrialised world for several G.M. Hagg . / Applied Ergonomics 34 (2003) 3–15 decades. A major point is that poor working conditions are related to quality deficiencies and vice versa. Thus, improved ergonomics is one way of achieving better quality, and there is today strong scientific support for such a view (Eklund, 1997) and an increasing awareness in industry of these relationships (Wilson, 1999). However, when reviewing the present documentation of company programmes in ergonomics, there are few explicitly declared links between ergonomics and quality policies. One example, from the automobile industry is the VCC KLE strategy (KLE Swedish acronym for Quality, Delivery and Economy) (Munck-Ulfsf.alt et al., 2003 this issue), where the ergonomics programme is an integral part of the quality strategy. At Volkswagen (VW) the relation between quality and ergonomics is acknowledged and applied in a process-audit programme for production development (Klatte et al., 1997). Axelsson (2000b) describes an intervention at an assembly line where the aims are twofold: improved quality and improved working conditions. These goals are reached by a participative process. 3.5. Participative aspects The participation of the employees on all levels in the development of the work and its environment is another important concept in modern ergonomics (Noro and Imada, 1991). The worker is supposed to be an expert in what he/she is doing the whole day. These thoughts are closely kindred with Japanese management philosophies like ‘‘kaizen’’ (Imai, 1986) which are also cornerstones in the quality movement. During the last decade, the necessity of a participatory approach has evolved into a truism in ergonomics. Hence, in almost all reviewed programmes it is stated that staff representatives from all levels act in various committees, involved in reactive as well as proactive work. Most investigators agree that a participatory approach is essential for the success of an ergonomics programme. However, an example, which illustrates that participation alone does not necessarily imply good ergonomics, is the NUMMI case (Adler et al., 1997). In spite of a participatory approach according to the Toyota production philosophy, severe musculoskeletal problems developed, leading to an OSHA citation. One reason for the problems was that the knowledge of ergonomics within the company was poor (Adler et al., 1997). One way of developing the participatory approach is to provide the operators with simple methods for selfassessment of the working conditions. An example of this is where the RULA method (McAtamney and Corlett, 1993) was taught and applied by assembly operators as a basis for ergonomic changes at the workplace (Axelsson, 2000b). Video-based methods, VIDAR and PSIDAR, addressing physical and psychosocial factors, respectively, have been developed for 7 similar purposes (Johansson Hanse and Forsman, 2001; Kadefors and Forsman, 2000). Another example of a genuine participative process is the change of assembly work, performed by the workers themselves, which is supported by external researchers (Odenrick and Arvidsson, 2000). This project is described in more detail below. 3.6. Health surveillance Good health among the staff is a basic objective in ergonomics. Medical health care directly provided by the employer is common in many large corporations (e.g. Brandenburg and Bubser, 1999; Stroud, 1999). Apart from being an employee benefit, it may provide an excellent tool for identifying problematic workstations and tasks (Hagberg et al., 1997; Smyth, 2003 this issue). Prerequisites for the efficacy of such a function are that the health care personnel are specially trained to identify a possible relationship between a disorder and the actual work conditions, and that they have direct feedback channels to company management on appropriate levels, in order to initiate appropriate action. Detailed health care statistics on workstation level, combined with price tags for the average rehabilitation costs of common diagnoses, as applied at SAAB Automobile, may highlight problem areas and their economical consequences, and serve as an incentive for management to change the conditions (Stroud, 1999). Another tool for the identification of health problems is active screening of the health of the workforce by different kinds of questionnaires (Kilbom, 1995; Smyth, 2003 this issue). According to Swedish and Norwegian law, some sort of surveillance system of this kind is mandatory for all enterprises (Systematic Work Environment Management) (SWEA, 2001). This law stimulates the establishment of ergonomics programmes. 3.7. Training and information A key issue when implementing an ergonomics programme in an enterprise is the training of the staff. In several programmes, the training efforts have been declared in more or less detail, aiming at various staff groups. For example, in the Volvo programme all levels, from top management to shop floor staff, receive tailored training programmes (Munck-Ulfsf.alt et al., 2003 this issue). Design and production engineers are trained to use checklists in their daily activities, which is . also the case at SAAB (Svensson and Sandstrom, 1995, 1997). The Boots Contract Manufacturing Programme has 2 days of training for ‘‘ergonomics champions’’, with one staff representative from each department (Smyth, 2003 this issue), and some other programmes show similar solutions (Baxter and Harrison, 2000; 8 G.M. Hagg . / Applied Ergonomics 34 (2003) 3–15 Munck-Ulfsf.alt et al., 2003 this issue). Another way of distributing information is by instruction videos (Moreau, 2003 this issue; Robertson et al., 2000). The GTI company in the Netherlands chose an unconventional approach, basing an information campaign in ergonomics on two popular cartoon characters who appeared on posters, hand-outs and mouse pads (Niggebrugge and Schelle, 1999). In large multinational corporations, the availability of ergonomics information is assured via Intranet systems (Evans et al., 2000; Oriet and Ewasyshyn, 1998). Another aspect of training is when individuals are trained to adopt a favourable work technique. This can be done just by observation and instruction by an ergonomist or by a senior staff member, specially trained for this function (Munck-Ulfsf.alt et al., 2003 this issue; Smyth, 2003 this issue). Another possibility is to use electromyographic feedback technique for training of minimal muscle exertion (H.agg, 1998). This approach was effectively used by Parenmark et al. (1988) at a chain saw plant, and the technique was still . in use in 1999 as a company routine (Hafstrom, 1999, personal communication). 4. Implementation The organisational implementation of ergonomics programmes varies substantially, depending on the type of company and company policies and organisation, as described in the presentations of this issue and other given examples. Most commonly, the operational responsibility for these programmes lies with the departments for occupational health and safety or on the ergonomics department if there is one. Usually, one or several ergonomics committees (depending on the size of the company and the number of plants) are founded. A common pattern is that a central committee has the overall responsibility for the activities, while the operational responsibility is taken on by local committees (e.g. (Baxter and Harrison, 1998; Gleaves and Mercurio, 1991; Joseph, 2003). These working committees normally consist not only of ergonomists but also of representatives from production and design engineering, production supervisors and shop floor personnel. At the start, the activities usually have to be limited to reactive measures, but if the programme is successful and is given reasonable resources to be established as a continuous process, the activities are expanded to involve proactive efforts as well. When investing in new production facilities or new products, proactive input to the change process is of vital importance for a future operation with higher quality, less health problems and greater satisfaction. Even if the proactive efforts are developed to an excellent level, it is important to preserve a continuous reactive readiness (see e.g. Smyth, 2003 this issue). Problems are likely to emerge, even in the best designed production process. 5. Examples of programmes from different business areas 5.1. The automotive industry The automotive industry has been claimed to be ‘‘the industry of industries’’ (Womack et al., 1990). Hence, the world’s largest manufacturing industry is a pioneer in many aspects of industrial development, and ergonomics is no exception. Car manufacturing involves many classical ergonomic risk factors such as repetitive work, awkward postures and hand-intensive work. Hence, the need for ergonomic considerations is obvious. Consequently, some of the most well-established ergonomics programmes reviewed in this paper originate from the automobile industry. The UAW/Ford manual, which was developed in cooperation with the University of Michigan (Joseph and Long, 1991), constitutes the basis for the Ford process of today, involving reactive as well as proactive measures (Joseph, 2003). The proactive activities address workstation as well as product design. Being one of the major car manufacturers with plants all over the world, efforts have been made to transfer the basic concept to other continents by translations and adaptations to local conditions. Ford also carries out applied research in-house (e.g. Stephens and Vitek, 1998). More specific guidelines for design and production engineers have been developed at SAAB Automobile . 1995, 1997), which also has a (Svensson and Sandstrom, developed process (Stroud, 1999). Similar work is going on within the General Motors Corporation (which owns SAAB) to achieve a global corporate standard in ergonomics (Stroud, 1999, personal communication). At present, detailed technical guidelines addressing physical factors are available (GM, 2000) but there is no description of the implementation process, training efforts, etc. The third big manufacturer in the USA, the Chrysler Corporation, also applies its own ergonomics programme (Oriet and Ewasyshyn, 1998). This programme includes traditional elements and has been established for a couple of years. However, the available documentation is sparse. VCC has developed an extensive programme and process, with all the traditional elements, as referred to above (Munck-Ulfsf.alt et al., 2003 this issue). The process is an integral part of the quality philosophy (see above). VCC was purchased by Ford in 1999. Recently, the since long established health care and ergonomics contractor, which to a large extent has been G.M. Hagg . / Applied Ergonomics 34 (2003) 3–15 responsible for the development of the ergonomics programmes at VCC (Munck-Ulfsf.alt et al., 2003 this issue), has been exchanged for another contractor with little experience from the vehicle businesses (MunckUlfsf.alt, 2002, personal communication). In Germany, VW has an extensive programme in health surveillance (Brandenburg and Bubser, 1999). The health care staff are also involved in ergonomic audits, as well as in the development process of new production units. The company also applies quality development through improved ergonomics (Klatte et al., 1997). However, these programmes seem to have no connection. Mercedes-Benz has developed a system for assembly production planning, which also takes ergonomics into account (Bullinger et al., 1997). However, it is not known whether this system is applied generally within the company or what other initiatives in ergonomics are taken. For the last couple of years, the Rover Group in Great Britain has been developing an ergonomic process partly based on a self-assessment method (ABA, German acronym for Associate Job Assessment) from their former German owner BMW, and also with development support from the University of Loughborough (Piotrowski, 2000). Peugeot in France is also venturing into an ergonomics programme initiated from their health department (Moreau, 2003 this issue). This programme mainly focuses on MSD prevention through the development and application of ergonomic assessment tools for reactive as well as proactive measures. Even if major trends in production planning and organisation have originated in Japan during the last few decades (e.g. kaizen and lean production), Japanese reports of ergonomics programmes in the Euro-American sense are sparse. Toyota reports about a programme avoiding back pain when remodelling assembly lines (Sugimoto et al., 1998). However, the case report about the Toyota transplant, NUMMI, in California indicates deficiencies regarding traditional ergonomics (Adler et al., 1997). 5.2. The electronics industry The electronics and computer industry has grown enormously since the Second World War. In spite of great progress in the automation of manufacturing, many tasks still require manual handling of different kinds, often at high repetitivity rates. At the same time, many new surveillance tasks requiring advanced technical knowledge have appeared. Thus, programmes in ergonomics are needed in this sector. One of the major companies, IBM, has for several decades applied ergonomics in production, and the activities have slowly matured, becoming an integrated part of the business during the 1990s (Helander and Burri, 1995). The programme incorporates all the 9 elements discussed above. In the paper, four case studies from different plants are described in addition to the ergonomics process. The measures are also evaluated economically and indicate substantial profits. In a study of a telecommunications manufacturing plant, a positive effect on MSD was obtained by a change of tools, and training in ergonomics of engineers and supervisors (McKenzie et al., 1985). Another successful intervention project addressing traditional ergonomics issues such as vibration levels, seating, postures and static loads, workforce training and health surveillance yielded a positive effect on MSD problems in an electromechanical plant over a period of 8 years (Chatterjee, 1992). Similar results were obtained by applying an observation technique and checklists (Herring and Wick, 1998). Aara( s and colleagues have long-term experience of introducing ergonomics at a company that manufactures telecommunication equipment (Aara( s and Westgaard, 1980; Aara( s, 1999). The main focus of the programme is the reduction of MSD through changes of workstation design in electronics assembly (Aara( s, 1994). The programme has been evaluated regarding the occurrence of MSD, and also in economical terms. As a result of substantial reduction in staff turnover and sick leave, the investments in better ergonomics were demonstrated to be highly profitable. 5.3. The food industry Within the food industry numerous adverse ergonomic factors are found. Especially in slaughterhouses and poultry industries, high repetitivity rates, high manual forces, awkward postures, and a cool environment create large problems. Hence, these businesses have appeared among the highest figures of MSD in official statistics for decades (e.g. NBOSH, 1999). Solving the disorder problems avoiding worker compensation claims are the main incentives, while quality issues are less emphasised. The problems in the red meat industry in the USA caused NIOSH to launch three intervention studies at three plants (Gjessing et al., 1994). One of these studies is also published and described separately (Moore and Garg, 1998). These studies were all supervised by an external expert in ergonomics or organisational behaviour. The summarised conclusions strongly advocate participatory approaches, involving staff members on all levels, i.e. engineers, supervisors, and operators in teams for ergonomic problem-solving. Other crucial prerequisites were training in ergonomics and team building for all participants, as well as support from ergonomics expertise and management. Experience from the implementation of another programme in the red meat industry was very much the same (Smith, 1994). 10 G.M. Hagg . / Applied Ergonomics 34 (2003) 3–15 5.4. Transportation Local distribution of goods by lorries and vans includes loading/unloading under varying conditions, which are often not controlled by the distributing company but by the customer. These circumstances often imply unacceptable conditions for the workers. For example, at the Scottish brewery Scottish & Newcastle (S&N) a majority of the draymen required early retirement due to MSD (Butler, 2003 this issue). Two main lines of approach were chosen. Firstly, vehicles, containers and transport procedures were assessed from an ergonomic point of view, and several improvements were implemented. Secondly, the cellars of the customers were inspected, and minimum requirements regarding physical accessibility were set and implemented. This latter problem is somewhat simplified, since S&N owns many of the pubs and restaurants where the deliveries are made. Similar problems in the Norwegian brewery Ringnes were solved in very much the same way (Bugge and Berger, 1994). The measures were evaluated economically and found profitable. The positive outcome has led to the formation of a Norwegian network (LUKS), involving other beverage and food distributors who apply the same kind of solutions. In Sweden, these problems are addressed in a national project (Maximum five steps), where the Swedish Brewery Association is one of the participants (Ros, 1999). 5.5. The office sector Today the ergonomics of office work is linked to a considerable extent to the fast development of information technology. The use of computers is associated with numerous MSD (Punnett and Bergqvist, 1997). Sight problems associated with VDUs are also common. Aara( s and colleagues have addressed these issues in a telecommunications company by company standards for office lighting and furniture, VDU placement and an individual optometric investigation with free special spectacles to be used at work (Aara( s, 1999; Aara( s et al., 1998). Another approach is described by Albin and colleagues who have started ‘‘office ergonomic clinics’’, where employees with MSD receive medical treatment but are also advised regarding computer ergonomics at a demonstration workstation (Albin, 1999; Albin et al., 1997). Yet another approach is described by Butler 2003 (this issue), who has developed a display screen equipment programme as a part of a larger programme. Baxter and Harrison (2000) describe a programme where selected operators from different telephone operator offices were trained for 2 days in basic office and computer ergonomics. These operators serve as ‘‘local experts’’ in their departments and teach ergo- nomics to their fellow workers. This programme has been evaluated economically, and indicates substantial savings. In three described cases, different variants of office ergonomics programmes in three companies are reported (Robertson et al., 2000). The training of the employees regarding office ergonomics in general and handling of personal adjustable equipment are emphasised as key elements in the programmes. 5.6. Miscellaneous A large enterprise making mainly cosmetics and healthcare products initiated an ergonomics programme by employing a full-time ergonomist (Smyth, 2003 this issue). In the paper, the progress after 2 years is reported. The programme includes ergonomic considerations when developing new equipment and processes, training of ‘‘ergonomic champions’’ among the operators within each department, learning proper working techniques and continuous health surveillance. The immediate identification of early MSD and corresponding problem-solving is especially stressed. Machine-sewing work is associated with static, sometimes awkward, postures. Hence MSD among professional sewers are common (Schibye et al., 1995). An ergonomics programme in a sewing industry was introduced by Halpern and Dawson (1997). The programme involved several improvements of the workstation and tools, organisation and also a structured resting and stretching schedule on a participatory basis. The approach involved expert-supported change groups with representatives for all staff categories. Risky work situations were identified by the experts; they also suggested changes to the change groups, who modified the suggestions before final implementation. One example of measures is the conversion from sitting to standing workstations. Another is the introduction of rest and stretch schedules. The programme resulted in substantially reduced MSD problems over a 5-year period. Baxter and Harrison (1998) describe the enforcement of ergonomics at BC TEL (telephone company in British Columbia, Canada) via a strong Human Factors Working Group, consisting of both union members and management members. This group is provided with the resources and the authority to carry out ergonomic changes and training in all areas and levels of the organisation. MSD problems and high absenteeism characterised a railway repair plant in Finland. A programme addressing procedures, tools and materials handling on a participatory basis improved the situation significantly by creating a better psychosocial climate, reducing absenteeism and MSD (Laitinen et al., 1998). G.M. Hagg . / Applied Ergonomics 34 (2003) 3–15 Another example where MSD problems initiated the development of an ergonomics programme is reported from a lighting manufacturing company (Gleaves and Mercurio, 1991). At the heart of the programme are ergonomic circles formed at each department, with representatives from all staff categories. The ergonomics work is centrally coordinated by a steering committee. These circles have come up with solutions to simple ergonomic problems as well as proactive work at new investments. The investigators also emphasise the improved collaboration between workers and management. In order to reduce the repetitivity of manual assembly work in a company making hearing protection devices, a change process was initiated (Odenrick and Arvidsson, 2000). This case is an example of how external ergonomics experts provide documentation of the prevailing situation as a basis for an improvement process based on the operators’ own experience and ideas. Teams of operators were formed, supported by the researchers, and solutions concerning how to design the new workstations, as well as how to change the work organisation, were developed by the teams. In a venture to improve working conditions as well as production quality in a company with unspecified assembly work, positive results were reported regarding MSD as well as quality (Axelsson, 2000b). The approach was based on participative self-assessment, applying the RULA method (McAtamney and Corlett, 1993). 6. Discussion The programmes reviewed in this paper are the ones that happen to be reported in scientific literature. These programmes most likely constitute only a fraction of all ergonomics programmes and processes in operation all over the world. Furthermore, the selection of available reports is a difficult matter. There are, for instance, a large number of field interventions reported by researchers, where the involvement of the company is doubtful. The chosen reports are considered to have genuine company support; however, in many cases this is hard to assess. To my knowledge, only two reviewed programmes have a representative from top management as a co-author (Munck-Ulfsf.alt et al., 2003 this issue; Oriet and Ewasyshyn, 1998). The scientific quality and wealth of detail in the reports varies considerably. Many of them are mainly descriptive with little or no evaluation and critical discussion. This is understandable when the author is a company representative who may not have an appropriate scientific training or, even if he/she has, cannot express criticism due to loyalty with the company or ventures. Only a restricted number of programmes in 11 this review have been evaluated by unbiased external researchers (Axelsson, 2000b; Helander and Burri, 1995; Laitinen et al., 1998; McKenzie et al., 1985; Moore and Garg, 1998). It is hard to critically assess the general structure a company programme is based on, often meagre, from reports written by people involved in the activities. Few general directives can be given regarding an optimal programme for a given company, since this depends on a large variety of local factors, such as the type of enterprise, company culture, national legislation and traditions. One conclusion is that more research, performed by external independent researchers, is needed to critically evaluate corporate initiatives in ergonomics. However, this does not imply that other reports are of no value. The fact that they have been carried out and reported must signify that most of them are likely to add value to the company. Furthermore, the assembled documentation provides a picture of the state of the art regarding the practical application of ergonomics, and can serve as a reference for practitioners considering venturing into similar programmes. Yet another problem is that all reports, including the scientifically good ones, are success stories. It is most likely that there are also programmes which have failed, and, maybe even more interesting, programmes that were never started due to resistance from the management. It would be most valuable to also have such cases reported, so as to be able to learn from the mistakes of others and to learn what hindrances there are for the introduction of ergonomics in working life. A good question is: What parameters should be addressed in an evaluation of an ergonomics programme? The ultimate parameter from the management point of view is, of course, the profitability of an investment in ergonomics. Some investigators carry out such estimations (Aara( s, 1994; Albin, 1999; Baxter and Harrison, 2000; Bugge and Berger, 1994; Butler, 2003 this issue; Helander and Burri, 1995), while others limit their economical evaluation to an estimation of the reduced costs (Brandenburg and Bubser, 1999; Halpern and Dawson, 1997; Moore and Garg, 1998). A conclusion is that ergonomics programmes should to a greater extent be fully economically evaluated in accordance with suggested methods and given examples (e.g. Oxenburgh, 1991, 1997) in order to demonstrate the economical value of such investments. A large number of programmes are evaluated in terms of MSD incidence and/or worker compensation claims (see Table 1), which is most likely equal to reduced costs. This mirrors the fact that most programmes are driven by health and safety professionals and ergonomists, whose main concern is the health and safety of the employees. In many cases, this seems to be a sufficient motive for sustaining a programme: ‘‘The protection 12 G.M. Hagg . / Applied Ergonomics 34 (2003) 3–15 and promotion of the employees’ health are at VW above all a humanitarian and social obligation’’ (Brandenburg and Bubser, 1999). ‘‘One of VCC’s core values is environmental care’’ (Munck-Ulfsf.alt et al., 2003 this issue). Aara( s states that a scientific evaluation of the effects on the workers’ health and comfort caused by the measures taken in ergonomics is essential for management approval at his company (Aara( s, 1999). A company policy of this kind is unfortunately too rare. In several evaluations of the effects on MSD, the claimed improvements may be caused by other courses of events within the company or the surrounding society. A demonstration of contrasts in the outcome in relation to suitable reference groups within and/or outside the company strongly supports a claimed improvement. Such comparisons are rarely seen. The possibility of a ‘‘Hawthorne effect’’ should be considered. Initial positive overreactions due to the measures taken are likely to be common. Opposite effects can also be seen. Increasing the ergonomic awareness in an organisation may also stimulate workers to report disorders that were previously not regarded as work related (Halpern and Dawson, 1997, Moore and Garg, 1998). Yet another common outcome of a company programme in ergonomics is the impact on company culture and psychosocial climate (Albin, 1999; Gleaves and Mercurio, 1991; Laitinen et al., 1998). These effects are hard to quantify but are most likely of great importance for a company in that they increase the commitment of the employees. As stated above, a participative approach has become more or less mandatory in ergonomics today, and almost all programmes include such elements. However, it is hard to know, based on the present documentation, to what extent the programmes live up to such declarations in practice. Own experience from Sweden indicates that declarations regarding participation may easily be overlooked, for example when the change process needs to be speeded up (Fredriksson et al., 2001). In several programmes, it is stated in general terms that working conditions are important for product quality. However, with three exceptions (Axelsson, 2000b; Klatte et al., 1997; Munck-Ulfsf.alt et al., 2003 this issue), these declarations are not substantiated any further. In spite of a strong focus on quality issues today, especially in the automotive industry, the connection between programmes mainly addressing physical factors reviewed here and quality programmes is weak. In the publication from VW regarding health and safety, quality is mentioned once in a subordinate clause (Brandenburg and Bubser, 1999), while there is obviously a parallel programme within the company focusing on ergonomics and quality issues (Klatte et al., 1997). The workstation assessment tool used by Toyota (Sugimoto et al., 1998) seems to be applied in parallel with and independent of continuous improvement and quality management programmes. It has recently been claimed that up to 50 per cent of quality problems in the manufacturing industry are due to a bad work environment (Axelsson, 2000a). From this perspective much remains to be done regarding the integration of quality and ergonomics programmes. However, in this context it should be noted that while the link between operator performance and product quality is strong for instance in the automotive industry, it is much weaker in other businesses such as the red meat industry (Moore and Garg, 1998), beverage distribution (Butler, 2003 this issue) or the cosmetics industry (Smyth, 2003 this issue). It has already been concluded that increased researcher involvement is desirable for critical evaluation. Another aspect of this is that researchers can provide expert input to the process. However, the role as expert must be strictly separated from the role as evaluator. It may be claimed that the well-established programmes at, e.g. Ford and VCC are, to a considerable extent, results of the long-lasting symbiotic collaboration with local research institutions. The value of researcher involvement is also emphasised in the Rover presentation (Piotrowski, 2000). Several other programmes rely on external researcher support (Axelsson, 2000b; Laitinen et al., 1998; Moore and Garg, 1998; Odenrick and Arvidsson, 2000). If expertise is not provided by researchers, it should be assured from consultants or hired professional ergonomists. Lack of expertise may jeopardize serious intentions, as shown in the NUMMI case (Adler et al., 1997). Ergonomics can be introduced in various ways, ranging from bringing in consultants to solve single problems, to the incorporation of ergonomics in the overall strategy of the company. Unfortunately, many companies still consider ergonomics as a health and safety issue only, and have not realised the potential of ergonomics for the development of the total efficiency of the company (Porter, 1998). Hopefully, more and more enterprises realise this potential as, e.g. described in the KLE strategy at VCC (Munck-Ulfsf.alt et al., 2003 this issue). In most cases, this is a maturation process which must take time (Albin, 1999). In recent years, emphasis has been given to the role of variation and duration aspects of the workload to avoid MSD (Winkel and Mathiassen, 1994). Rotation between workstations is recommended in general terms in several programmes, but it is remarkable that working hours, breaks, job rotation, etc. are rarely addressed. Generally, the connection between work organisation and adverse physical exposure has been overlooked. In the Ford programme presented in this issue, it is clearly stated that ‘‘Ford’s primary control strategy is to use engineering controls’’ (Joseph, 2003). However, the next sentence declares that ‘‘the most effective controls often G.M. Hagg . / Applied Ergonomics 34 (2003) 3–15 involve a combination of both engineering and administrative controls’’. In the presentation from Peugeot in the present issue, these conditions are clearly illustrated by the increase of the MSD incidence rate when the cycle time on the assembly line was drastically reduced, in spite of substantial measures to improve traditional ergonomic conditions such as heavy lifts and awkward postures (Moreau, 2003 this issue). Own experience shows very much the same reactions when introducing an assembly line with improved postures instead of off-line workstations (Fredriksson et al., 2001). Moreau is aware of these shortcomings in the present ergonomic assessment tools at Peugeot. Thus, in companies where there are monotonous, repetitive work tasks, e.g. in car manufacturing, electronics assembly work, or meatpacking, a much clearer focus on organisational issues is needed to achieve an improvement of working conditions. Conclusions * * * * * * * Corporate initiatives in ergonomics are important for productivity, quality and staff well being in many enterprises. A participative approach is a basic prerequisite for the success of a programme. Expertise in ergonomics, external or internal, is also essential. More research should be carried out regarding the effectiveness of such programmes. There are few examples where quality and ergonomics programmes are integrated. A majority of the programmes reviewed are mainly considered as a health and safety issue. Much work remains to be done in order to achieve an integration of ergonomics and general company policies. There should be a clearer focus on organisational issues such as job rotation and working times. References Aar(as, A., 1994. The impact of ergonomic intervention on individual health and corporate prosperity in a telecommunications environment. Ergonomics 37, 1679–1696. Aar(as, A., 1999. Experience from co-operation in ergonomics during a . 25 year period. In: Wikstrom, B.O., H.agg, G.M. (Eds.) Corporate Initiatives in Ergonomics, Arbete & H.alsa 1999:10, NIWL, Stockholm, pp. 86–91. Aar(as, A., Westgaard, R.H., 1980. The organisation and execution of work environmental projects in a Norwegian industrial company. Ergonomics 23, 707–726. Aar(as, A., Horgen, G., Bjrset, H.-H., Ro, O., Thoresen, M., 1998. Musculoskeletal, visual and psychosocial stress in VDU operators before and after multidisciplinary ergonomic interventions. Appl. Ergon. 29, 335–354. Adler, P., Goldoftas, B., Levine, D., 1997. Ergonomics, employee involvement and the Toyota production system: a case study of 13 NUMMI’s 1993 model introduction. Ind. Labor. Relat. Rev. 50, 416–437. Albin, T., 1999. Maturation and development of the ergonomics . process within a large, multinational corporation. In: Wikstrom, B., H.agg, G. (Eds.), Corporate Initiatives in Ergonomics, Arbete & H.alsa 1999:10, NIWL, Stockholm, pp. 92–95. Albin, T., Hebaus, M., Ley, C., 1997. Office-ergonomics clinic results at thirty months. J. Occup. Environ. Med. 39, 1031. Axelsson, J.R.C., 2000a. Quality and ergonomics. Towards successful . integration. Doctoral Thesis, University of Linkoping. Axelsson, J.R.C., 2000b. ‘RULA in action building the SIMPLE framework for integrated quality and ergonomics improvements’ in Quality and ergonomics. Towards successful integration. Doctoral . Thesis, University of Linkoping, pp. 211–248. Baxter, K., Harrison, D., 1998. Spreading out the workload: Ergonomics by committee. In: Kumar, S. (Ed.), Advances in Occupational Ergonomics and Safety, Vol. 2. IOS Press, Amsterdam, pp. 127–130. Baxter, K., Harrison, D., 2000. A simple cost benefit analysis for an ergonomics ‘‘train-the-trainer’’ program. In: IEA-2000, Vol. 2. HFES, San Diego, pp. 1–3. Brandenburg, U., Bubser, R., 1999. Health management at VOLKS. WAGEN. In: Wikstrom, B.O., H.agg, G.M. (Eds.), Corporate Initiatives in Ergonomics, Arbete & H.alsa 1999:10, NIWL, Stockholm, pp. 62–68. Broberg, O., 1997. Integrating ergonomics into the product development process. Int. J. Ind. Ergon. 19, 317–327. Bugge, S., Berger, J., 1994. Bridging the gap between ergonomical knowledge, work design and organisation. In: McFadden, S., Innes, L., Hill, M. (Eds.), IEA-94, Vol. 6, HFAC, Toronto, pp. 56–59. Bullinger, H., Rally, P., Schipfer, J., 1997. Some aspects of ergonomics in assembly planning. Int. J. Ind. Ergon. 20, 389–397. Butler, M., 2003. Corporate ergonomics programme at Scottish & Newcastle. Appl. Ergon. 34 (1), 35–38. Chatterjee, D., 1992. Workplace upper limb disorders: a prospective study with intervention. J. Soc. Occup. Med. 42, 129–136. Eklund, J., 1997. Ergonomics, quality and continuous improvement— conceptual and empirical relationships in an industrial context. Ergonomics 40, 982–1001. Evans, S.M., Kilduff, H.R., Joseph, B.S., Turner, E.H., 2000. [email protected]: using the intranet to enhance program effectiveness. In: IEA-2000, Vol. 1, HFES, San Diego, pp. 465–468. ( . Fredriksson, K., Bildt Thorbjornsson, C., H.agg, G.M., Kilbom, A., 2001. The impact on musculoskeletal disorders of changing physical and psychosocial work environment conditions in the automobile industry. Int. J. Ind. Ergon. 28, 31–45. Gjessing, C., Schoenborn, T., Cohen, A. (Eds.), 1994. Participatory Ergonomic Interventions in Meatpacking Plants. NIOSH, Cincinnati. Gleaves, S.M., Mercurio, J.J., 1991. Ergonomic circles in assembly line manufacturing. In: Pulat, B.M., Alexander, D.C. (Eds.), Industrial ergonomics, case studies. Industrial Engineering & Management Press, Norcross, GA, pp. 287–293. GM, 2000. Manufacturing ergonomics. Recommendations ERG 1.2, General Motors Technical Center, Warren, MI. Hagberg, M., Silverstein, B., Wells, R., Smith, M.J., Hendrick, H., Carayon, P., P!erusse, M., 1995. Work Related Musculoskeletal Disorders (WMSDs): A Reference Book for Prevention. Taylor & Francis, London. ( Hagberg, M., Buckle, P., Fine, L., Franzblau, A., Kilbom, A., Menckel, E., Punnett, L., Riihim.aki, H., Silverstein, B., ViikariJuntura, E., 1997. Health surveillance of work-related musculoskeletal disorders as a tool in ergonomics. In: Sepp.al.a, P., Luopaj.arvi, T., Nyg(ard, H., Mattila, M. (Eds.), IEA’97. Finnish Institute of Occupational Health, Tampere, pp. 274–276. 14 G.M. Hagg . / Applied Ergonomics 34 (2003) 3–15 H.agg, G., 1998. Biofeedback, In: Mital, A., Kumar, S. (Eds.), Industrial and Occupational Ergonomics. Users’ Encyclopedia CD-ROM, Cincinnati. Int. J. Ind. Eng. Halpern, C., Dawson, K., 1997. Design and implementation of a participatory ergonomics program for machine sewing tasks. Int. J. Ind. Ergon. 20, 429–440. Helander, M., Burri, G., 1995. Cost effectiveness of ergonomics and quality improvements in electronics manufacturing. Int. J. Ind. Ergon. 15, 137–151. Helander, M., Nagamichi, M. (Eds.), 1992. Design for Manufacturability: a Systems Approach to Concurrent Engineering and Ergonomics. Taylor & Francis, London. Herring, C., Wick, J., 1998. Reducing the probability of ergonomics related injuries in manufacturing. In: Kumar, S. (Ed.), Advances in Occupational Ergonomics and Safety, Vol. 2. IOS Press, Amsterdam, pp. 69–72. Imai, M., 1986. Kaizen. The Key to Japan’s Competitive Success. Random House, New York. Jimmerson, D.G., 1998. Ergonomics analysis software in vehicle manufacturing/assembly—a comprehensive approach. In: Kumar, S. (Ed.), Advances in Occupational Ergonomics and Safety, Vol. 2, IOS Press, Amsterdam, pp. 661–664. Johansson Hanse, J., Forsman, M., 2001. Identification and analysis of unsatisfactory psychosocial work situations: a participatory approach employing video-computer interaction. Appl. Ergon. 32, 23–29. Joseph, B., 2003. Corporate ergonomics programme at The Ford Motor Company. Appl. Ergon. 34 (1), 23–28. Joseph, B., Long, M. (Eds.), 1991. Fitting Jobs to People—an Ergonomics Process. The UAW-Ford National Joint Committee on Health and Safety, Dearborn. Kadefors, R., Forsman, M., 2000. Ergonomic evaluation of complex work: a participative approach employing video-computer interaction, exemplified in a study of order picking. Int. J. Ind. Ergon. 25, 435–445. ( Kilbom, A., 1995. Questionnaire—experience with the Nordic Questionnaires. In: Hagberg, M., Viikari-Juntura, E., Grieco, A. (Eds.), Active Health Surveillance of Workrelated Musculoskeletal Disorders: an International course and workshop, Vol. 36, Unders.okningsrapport, NIWL, pp. 9–10. Klatte, T., Daetz, W., Laurig, W., 1997. Quality improvement through capable processes and ergonomic design. Int. J. Ind. Ergon. 20, 399–411. . M., Rasa, P., 1998. Improving physical Laitinen, H., Saari, J., Kivisto, and psychosocial working conditions through a participatory ergonomic process. A before-after study at an engineering workshop. Int. J. Ind. Ergon. 21, 35–45. Lillrank, P., Kano, N., 1989. Continuous improvements—quality control circles in Japanese industry. University of Michigan, Ann Arbor. McAtamney, L., Corlett, E.N., 1993. RULA: a survey method for the investigation of work-related upper limb disorders. Appl. Ergon. 24, 91–99. McKenzie, F., Storment, J., Van Hook, P., Armstrong, T., 1985. A program for control of repetitive trauma disorders associated with hand tool operations in a telecommunications manufacturing facility. Am. Ind. Hyg. Assoc. J. 46, 674–678. Moore, J., Garg, A., 1998. The effectiveness of participatory ergonomics in the red meat packing industry. Evaluation of a corporation. Int. J. Ind. Ergon. 21, 47–58. Moreau, M., 2003. Corporate ergonomics programme at automobiles Peugeot-Sochaux. Appl. Ergon. 34 (1), 29–34. Munck-Ulfsf.alt, U., Falck, A., Forsberg, A., Dahlin, C., Eriksson, A., 2003. Corporate ergonomics programme at Volvo Car Corporation. Appl. Ergon. 34 (1), 17–22. NBOSH, 1998. Ergonomics for the prevention of musculoskeletal disorders. AFS 1998:1E, Swedish National Board of Occ Safety & Health, Solna. NBOSH, 1999. Occupational diseases and occupational accidents 1997. Official statistics, National Board of Occupational Safety and Health, Stockholm. Niggebrugge, D., Schelle, D., 1999. Common sense at GTI. . In: Wikstrom, B., H.agg, G. (Eds.), Corporate Initiatives in Ergonomics, Arbete & H.alsa 1999:10, NIWL, Stockholm, pp. 100–103. Noro, K., Imada, A. (Eds.), 1991. Participatory Ergonomics. Taylor & Francis, London. Odenrick, P., Arvidsson, I., 2000. Ergonomic change processes in the production of an industrial company. In: IEA-2000, Vol. 5. San Diego, HFES, pp. 136–137. Oriet, L., Ewasyshyn, F., 1998. Ergonomic implications for new technology guidelines for automotive manufacturers. In: Kumar, S. (Ed.), Advances in Occupational Ergonomics and Safety, Vol. 2. IOS Press, Amsterdam, pp. 657–660. Oxenburgh, M., 1991. Increasing productivity and profit through health and safety—case studies in successful occupational health and safety practice. CCH International, North Ryde, NSW, Australia. Oxenburgh, M.S., 1997. Cost-benefit analysis of ergonomics programs. Am. Ind. Hyg. Assoc. J. 58, 150–156. Parenmark, G., Engvall, B., Malmkvist, A.-K., 1988. Ergonomic on-the-job training of assembly workers. Appl. Ergon. 19, 143–146. Piotrowski, R., 2000. Ergonomic self reliance. A structured approach. In: IEA-2000, Vol. 2. HFES, San Diego, pp. 450–453. Porter, M., 1998. Justifying the incorporation of ergonomics into organisational strategy—beyond single issue solving. In: Kumar, S. (Ed.), Advances in Occupational Ergonomics and Safety, Vol. 2. IOS Press, Amsterdam, pp. 119–122. Punnett, L., Bergqvist, U., 1997. Visual display unit work and upper extremity musculoskeletal disorders—a review of epidemiological findings. Vol. 16. Arbete & H.alsa 1997:16, Arbetslivsinstitutet. Robertson, M.M., Robinson, M., Chen, P., 2000. Office ergonomic interventions: strategies and practices. In: IEA-2000, Vol. 2. HFES, San Diego, pp. 165–168. . Ros, M., 1999. Hogst fem steg (In Swedish). Occupational health clinic, Karolinska hospital, Stockholm. Schibye, B., Skov, T., Ekner, D., Christiansen, J., Sjgaard, G., 1995. Musculoskeletal symptoms among sewing machine operators. Scand. J. Work Environ. Health 21, 427–434. Siffer, L., Jimmerson, G., 2000. Electrical connector acceptability rating (ECAR): ergonomic guidelines for electrical connectors for vehicle component assembly. In: IEA-2000, Vol. 5. HFES, San Diego, pp. 344–346. Smith, M., 1994. A case study of a participatory ergonomics and safety program in a meat processing plant. In: McFadden, S., Innes, L., Hill, M. (Eds.), IEA-94, Vol. 6. HFAC, Toronto, pp. 114–116. Smyth, J., 2003. Corporate ergonomics programme at BCM Airdrie. Appl. Ergon. 34 (1), 39–43. Stephens, A., Vitek, M., 1998. Dynamic impact forces for vehicle assembly measurement guidelines. In: Kumas, S. (Ed.), Advances in Occupational Ergonomics and Safety, Vol. 2. IOS Press, Amsterdam, pp. 678–681. Stroud, S., 1999. Ergonomics at SAAB, from design to the shop floor . B.O., H.agg G.M. (Eds.) Corporate and back again. In: Wikstrom initiatives in Ergonomics, Arbete & H.alsa 1999:10, NIWL, Stockholm, pp. 59–61. Sugimoto, Y., Iritani, T., Koide, I., 1998. Strategy for health and safety management at an automobile company. In: Kumar, S. G.M. Hagg . / Applied Ergonomics 34 (2003) 3–15 (Ed.), Advances in Occupational Ergonomics and Safety, Vol. 2. IOS Press, Amsterdam, pp. 669–672. Svensson, I., Sandstr.om, R., 1995. Ergonomic strain assessment guidelines, SAAB production. SAAB Automobile AB, Trollh.attan. Svensson, I., Sandstr.om, R., 1997. Ergonomic strain assessment guidelines, SAAB design, SAAB Automobile AB, Trollh.attan. SWEA, 2001. Systematic Work Environment Management, AFS 2001:1, Swedish Work Environment Agency, Solna. Westgaard, R., Winkel, J., 1997. Ergonomic intervention research for improved musculoskeletal health: a critical review. Int. J. Ind. Ergon. 20, 463–500. 15 Wilson, J., 1999. Interactions as the focus for human centered systems. In: Axelsson, J., Bergman, B., Eklund, J. (Eds.), TQM and Human Factors, Vol. 1. Centre for studies of humans, . technology and organization, Linkoping, pp. 35–43. Winkel, J., Mathiassen, S.E., 1994. Assessment of physical work load in epidemiologic studies: concepts, issues and operational considerations. Ergonomics 37, 979–988. Womack, J., Jones, D., Roos, D., 1990. The Machine that Changed the World. Rawson Associates, New York.