LEEST

François Daniellou is Professor of Ergonomics at the Institute of Technology of Bordeaux University. His research field is the introduction of ergonomics in design project management, with emphasis on musculoskeletal disorders, psychosocial risks and technological accidents prevention. The International Ergonomics Association bestowed him the 2009 Outstanding Educators Award. francois.daniellou@ensc.fr

MSD risk factors that are commonly addressed, such as repetitiveness, strength, posture, have themselves higher level determinants (Bellemare et al., 2002). Those are product design, production organisation, workplace design choices, human resource management, general management style, and so on. The main prevention challenge is to tackle not only the risk factors at the workplace but their sources in the organisation. This requires a model of the relations between macro determinants and micro consequences, and models of efficient prevention interventions.
Any workplace is a place where meet : i) an anticipation of production operations, made by the designers and organisers by means of general knowledge (and beliefs) ; ii) an ability to cope with the real time variability of production components, that is made of individual embodied knowledge and collective rules of the trade. In most situations, the organisation underestimates the level of variability, what is required from the workers to cope with it, and the costs that the discrepancy implies. Therefore, the workers undergo a lack of room for manoeuvre to deal with what has not been anticipated. Production cycles never go as they are supposed to, and the micro reality requires a constant effort of the workers to deal with incidents. MSDs are often a consequence of organisations who aim at a high level of production flexibility with a high organisational rigidity. An assessment of biomechanical risk factors carried out on the basis of a normal standard cycle has little to do with the ongoing accelerations and stops that really occur.
A 3 year study about “sustainable MSD prevention” (Caroly et al, 2007, Coutarel et al., 2006) in middle size companies in France has highlighted the extent to which organisations are frequently overwhelmed by the discrepancy between anticipation and real operations. This results into unofficial stocks, not adapted tools, series of accelerations and breakdowns, delays, quality defects, and so on. The lack of organisational feedback and taking in account of workers’ knowledge is obvious. The approximate translation of so-called “Japanese” organisational measures leads to a combination of organisational mess and an impossibility for the workers to criticize it. Hidden costs (absenteeism and its management, quality losses, delays, loss of brand image...) have been demonstrated to be 10 to 30 times as much as the direct cost of occupational diseases.
Addressing MSD prevention requires a collective awareness of the relation between health hazards and production pitfalls (Winkel & Neumann, 2007). Therefore, a specific project management may be developed, including following ingredients :

• MSDs are not (only) a medical problem, they are a strategic issue for the organisation. Therefore upper management’s involvement and commitment are required.
• MSD are one symptom of a more general organisational syndrome, which includes difficulties for the middle management and lack of decision power for the plant management. Production limitations must be addressed simultaneously with health hazards.
• MSD prevention requires new forms of dialog between all stake holders (decision makers, designers, personnel representatives, health staff, workers including middle management), and relevant forms of participation.
• One other symptom of the MSD syndrome is the general belief that “nothing else is possible”, which is a defence built by the actors in response to their feeling of impotence. Designing and implementing collectively quick solutions are not the final response, but may be a way to make it possible for the actors to overcome this hang-up.

MSD prevention requires experimentation of daring participatory forms of redesign project management. This raises an epistemological problem, since “randomized controlled trials” are not possible when the point is to show the relevance of specific forms of participation. An alternative is qualitative research, based on monographs. A detailed description of a number of interventions, including a systematically framed description of the request, the company context, the underlying theories and models of the consultants, the planned components of the intervention, their real implementation, and the assessed effects (Baril-Gingras et al., 2006, Bellemare et al., 2007, Berthelette, 2006, Messing et al., 2005) might provide a relevant database to detect regularities and feed the professional practice and teaching.

References :
Baril-Gingras, G., Bellemare, M., Poulin, P., 2006, OHS external interventions qualitative analysis : an example of the contribution of social sciences, in International Congress of SafetyNet and l’Association canadienne de recherche en santé au travail / ACRST, (7-8 juin, 2006 : St-Jean, Terre-Neuve-et-Labrador, Canada).
Bellemare, M., Marier, M., Montreuil, S., Allard, D., Prévost, J., La transformation des situations de travail par une approche participative en ergonomie : une recherche intervention pour la prévention des troubles musculo-squelettiques, Rapport R-292, Montreal : IRSST, http://www.irsst.qc.ca/fr/_publicat...
Bellemare, M., Baril-Gingras, G., Poulin, P., Ross, J., 2007, Analysis of the socio-organizational aspects of an intervention : tool for process evaluation studies, in Proceedings of PREMUS 2007 : Sixth International Scientific Conference on Prevention of Work-related Musculoskeletal Disorders, p. 140
Berthelette, D., Leduc, N., Bilodeau, H., Faye, C., Loignon, C., 2006, From Underlying Theory to Program Delivery : The Safe Patient Transfer Training Program. Proceedings of the 16th World Congress on Ergonomics, International Ergonomics Association, Maastricht, The Netherlands
Caroly, S., Coutarel, F., Daniellou, F., Landry, A., Escriva, E., Roquelaure, Y., 2007. Assessment if the interventions of sustainable prevention of musculoskeletal disorders : comparison of twenty companies. Proceedings of PREMUS 2007, Sixth international scientific conference on prevention of work-related musculoskeletal disorders, Boston, USA
Coutarel, F., Daniellou, F., Dugué, B., Landry, A., Caroly, S., Cholez, C., Roquelaure, Y. and Douillet, P., 2006, Sustainable prevention of musculoskeletal disorders : methodological aspects of a project on assessment of the efficiency of interventions, Proceedings of International Ergonomics Association Congress, Maastricht.
Messing, K., Seifert, A.M., Vézina, N., Balka, E., Chatigny, C., 2005. Qualitative research using numbers : Analysis developed in France and used to transform work in North America. New Solutions : A Journal of
Environmental and Occupational Health Policy 15(3) : 245-260 Winkel, J. and Neumann, P., 2007, Ergonomics and effective production systems – moving from reactive to proactive development, Stockholm, Swedish National Institute for Working Life.