Macdonald Wendy, Oakman Jodi
Centre for Ergonomics & Human Factors, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, 3086, Australia.
BMC Musculoskelet Disord. 2015 Oct 14;16:293. doi: 10.1186/s12891-015-0750-8.
Exposures to occupational hazards substantially increase workers' risk of developing musculoskeletal disorders (MSDs) and can exacerbate pre-existing disorders. The effects on MSD risk of the physical requirements of work performance are well recognised, but there is now ample evidence that work-related psychosocial hazards can also have substantial effects; further, some hazards may be additive or interactive. This evidence is not reflected in current workplace risk management practices.
Barriers to more effective workplace management of MSD risk include: the widespread belief that risk arises largely or entirely from physical hazard exposures; regulatory and guidance documents targeting MSDs, most of which reflect this belief; risk assessment tools that focus narrowly on subsets of mainly physical hazards and yet generate outputs in the form of MSD risk indicators; and the conventional occupational health and safety (OHS) risk management paradigm, which is ill-suited to manage MSD risk. It is argued that improved workplace management of MSD risk requires a systems-based management framework and more holistic risk assessment and control procedures that address risk from all types of hazard together rather than in isolation from each other, and that support participation by workers themselves. New MSD risk management tools are needed to meet these requirements. Further, successful implementation of such changes is likely to require some restructuring of workplace responsibilities for MSD risk management. Line managers and supervisors often play key roles in generating hazards, both physical and psychosocial, so there is a need for their more active participation, along with OHS personnel and workers themselves, in routine risk assessment and control procedures. MSDs are one of our largest OHS problems, but workplace risk management procedures do not reflect current evidence concerning their work-related causes. Inadequate attention is given to assessing and controlling risk from psychosocial hazards, and the conventional risk management paradigm focuses too narrowly on risk from individual hazards rather than promoting the more holistic approach needed to manage the combined effects of all relevant hazards. Achievement of such changes requires new MSD risk management tools and better integration of the roles of OHS personnel with those of line managers.
接触职业危害会大幅增加工人患肌肉骨骼疾病（MSD）的风险，并可能使已有的疾病恶化。工作表现的身体要求对MSD风险的影响已得到充分认识，但现在有充分证据表明，与工作相关的心理社会危害也可能产生重大影响；此外，一些危害可能具有相加或相互作用的效果。这一证据并未反映在当前的工作场所风险管理实践中。
对MSD风险进行更有效工作场所管理的障碍包括：普遍认为风险主要或完全源于身体危害暴露；针对MSD的监管和指导文件，其中大多数反映了这一观点；风险评估工具狭隘地关注主要身体危害的子集，但却以MSD风险指标的形式生成结果；以及传统的职业健康与安全（OHS）风险管理范式，该范式不适用于管理MSD风险。有人认为，改善工作场所对MSD风险的管理需要一个基于系统的管理框架以及更全面的风险评估和控制程序，这些程序应共同处理来自各类危害的风险，而不是彼此孤立地处理，并且要支持工人自身的参与。需要新的MSD风险管理工具来满足这些要求。此外，成功实施此类变革可能需要对MSD风险管理的工作场所责任进行一些重组。直线经理和主管在产生身体和心理社会危害方面往往起着关键作用，因此需要他们与OHS人员以及工人自身更积极地参与日常风险评估和控制程序。MSD是我们最大的OHS问题之一，但工作场所风险管理程序并未反映有关其与工作相关原因的当前证据。对心理社会危害风险的评估和控制关注不足，传统风险管理范式过于狭隘地关注个体危害的风险，而不是促进管理所有相关危害综合影响所需的更全面方法。实现此类变革需要新的MSD风险管理工具以及更好地整合OHS人员与直线经理的角色。
