BACKGROUND:Methods of delivering occupational safety and health (OSH) training have shifted from in-person to online. Widespread delivery of a standardized OSH training course in three modalities in the province of Ontario, Canada allowed measurement of differences in their effectiveness. METHODS:Learners (N = 899) self-selected into face-to-face (F2F) instructor-led learning, online instructor-led synchronous distance learning, or online self-paced e-learning. Pre- and post-training surveys collected information on knowledge and other measures. Multiple regression analyses compared modalities on knowledge achievement (0%-100% scale; the primary outcome), engagement, perceived utility, perceived applicability, self-efficacy, and intention-to-use. RESULTS:F2F learners achieved a statistically significant 2.5% (95% CI: 0.3%, 4.7%) higher post-training knowledge score than distance learners (Cohen's d = 0.23, which is considered small). A statistically insignificant difference of 0.4% (95%: -1.4%, 2.3%) was seen between e-learners and distance learners. Collaborating training providers regarded these differences as not meaningful in practice. Statistically significant differences between modalities were seen for engagement, perceived utility, and self-efficacy. Scores of F2F learners were more favorable than scores of distance learners, which were, in turn, more favorable than scores of e-learners. CONCLUSIONS:This study provides evidence that there are small to no differences among F2F, distance and e-learning in their ability to ensure knowledge achievement among learners. This finding is likely generalizable to other well-designed short-term OSH training aimed at acquiring new knowledge. More research is needed to understand whether there are important differences across these modalities in basic OHS skill acquisition and transfer of learning to the workplace.

The province of Ontario, Canada, implemented mandatory day-long training for construction workers required to use fall-protection equipment. More than 400 000 training sessions were completed by 2017 when the requirement took full effect. The lost-time workers’ compensation claim incidence rate attributable to falls targeted by the training was 19% lower in 2017–2019 than in 2012–2014. Rates for two comparator injuries increased or stayed the same. The decline in targeted fall claim incidence rate of the other Canadian provinces was 6%. (Am J Public Health. 2024;114(1):38–41. https://doi.org/10.2105/AJPH.2023.307440 )

OBJECTIVES:To examine the association between precarious employment and risk of occupational injury or illness in Ontario, Canada. METHODS:We combined accepted lost-time compensation claims from the Workplace Safety and Insurance Board with labour force statistics to estimate injury and illness rates between January 2016 and December 2019. Precarious employment was imputed using a job exposure matrix and operationalised in terms of temporary employment, low wages, irregular hours, involuntary part-time employment and a multidimensional measure of 'low', 'medium', 'high' and 'very high' probabilities of exposure to precarious employment. Negative binomial regression models examined exposure to precarious employment in relation to risk of occupational injury or illness. RESULTS:After adjusting for age, sex and year, all indicators of precarious employment were associated with increased risk of injury or illness. Workers with 'high' and 'very' high' exposure to precarious employment presented a nearly threefold risk of injury or illness (rate ratio (RR): 2.81, 95% CI 2.73 to 2.89; RR: 2.82, 95% CI 2.74 to 2.90). Further adjustment for physical demands and workplace hazards attenuated associations, though a statistically and substantively significant exposure-outcome relationship persisted for workers with 'high' and 'very high' exposures to precarious employment (RR: 1.65, 95% CI 1.58 to 1.72; RR: 2.00, 95% CI 1.92 to 2.08). CONCLUSIONS:Workers exposed to precarious employment are more likely to sustain a lost-time injury or illness in Ontario, Canada. Workplace health and safety strategies should consider the role of precarious employment as an occupational hazard and a marker of work injury risk.

Objective To examine the association between precarious employment and risk of work-related COVID-19 infection in Ontario, Canada.Methods We combined data from an administrative census of workers' compensation claims with corresponding labour force statistics to estimate rates of work-related COVID-19 infection between April 2020 and April 2022. Precarious employment was imputed using a job exposure matrix capturing temporary employment, low wages, irregular hours, involuntary part-time employment and a multidimensional indicator of 'low', 'medium', 'high' and 'very high' overall exposure to precarious employment. We used negative binomial regression models to quantify associations between precarious employment and accepted compensation claims for COVID-19.Results We observed a monotonic association between precarious employment and work-related COVID-19 claims. Workers with 'very high' exposure to precarious employment presented a nearly fivefold claim risk in models controlling for age, sex and pandemic wave (rate ratio (RR): 4.90, 95% CI 4.07 to 5.89). Further controlling for occupational exposures (public facing work, working in close proximity to others, indoor work) somewhat attenuated observed associations. After accounting for these factors, workers with 'very high' exposure to precarious employment were still nearly four times as likely to file a successful claim for COVID-19 (RR: 3.78, 95% CI 3.28 to 4.36).Conclusions During the first 2 years of the pandemic, precariously employed workers were more likely to acquire a work-related COVID-19 infection resulting in a successful lost-time compensation claim. Strategies aiming to promote an equitable and sustained recovery from the pandemic should consider and address the notable risks associated with precarious employment.

Objectives To understand rates of work-related COVID-19 (WR-C19) infection by occupational exposures across waves of the COVID-19 pandemic in Ontario, Canada.Methods We combined workers' compensation claims for COVID-19 with data from Statistics Canada's Labour Force Survey, to estimate rates of WR-C19 among workers spending the majority of their working time at the workplace between 1 April 2020 and 30 April 2022. Occupational exposures, imputed using a job exposure matrix, were whether the occupation was public facing, proximity to others at work, location of work and a summary measure of low, medium and high occupational exposure. Negative binomial regression models examined the relationship between occupational exposures and risk of WR-C19, adjusting for covariates.Results Trends in rates of WR-C19 differed from overall COVID-19 cases among the working-aged population. All occupational exposures were associated with increased risk of WR-C19, with risk ratios for medium and high summary exposures being 1.30 (95% CI 1.09 to 1.55) and 2.46 (95% CI 2.10 to 2.88), respectively, in fully adjusted models. The magnitude of associations between occupational exposures and risk of WR-C19 differed across waves of the pandemic, being weakest for most exposures in period March 2021 to June 2021, and highest at the start of the pandemic and during the Omicron wave (December 2021 to April 2022).Conclusions Occupational exposures were consistently associated with increased risk of WR-C19, although the magnitude of this relationship differed across pandemic waves in Ontario. Preparation for future pandemics should consider more accurate reporting of WR-C19 infections and the potential dynamic nature of occupational exposures.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

BACKGROUND:This study examined the effectiveness of synchronous online learning (SOL) for occupational purposes relative to face-to-face (F2F) learning.METHODS:Seven bibliographic databases were searched, and publications meeting the inclusion criteria were sought. Title and abstract screening, article screening, methodological quality assessment, and data extraction were carried out by two independent reviewers.RESULTS:Three systematic reviews meeting the inclusion criteria were consistent in providing evidence that there was generally no difference between SOL and F2F learning in their effects on knowledge or skills.CONCLUSIONS:Based on the sparse evidence base examined in this review, we conclude that SOL and traditional F2F learning for occupational or career preparation purposes are similarly effective for learners at the undergraduate level or higher. Much caution should be taken with this assumption when delivering content of a more hands-on nature and when adult learners have less educational preparation, since research is lacking in these areas.

ObjectiveTo replicate, in a more recent time period, a previous cross-sectional study to estimate the association between unionisation and the risk of workers’ compensation injury claims.MethodsThe sampling frame was workers’ compensation company account records in the industrial, commercial and institutional construction sector in the province of Ontario, Canada, 2012–2018. Company unionisation status was determined through linkage with records of unionised contractors. Outcomes were cumulative counts of workers’ compensation injury claims, aggregated to company business. Risk ratios were estimated with multivariable negative binomial regression models. Models were also fit separately to lost-time claims stratified by company size.ResultsBusiness unionisation was associated with a lower lost-time claim incidence (crude risk ratio, CRR=0.69, 95% CI 0.65 to 0.74); adjusted risk ratio, ARR=0.75, 95% CI 0.71 to 0.80). In subgroup analyses, the magnitude of the ARR declined as company size decreased and was not statistically significant for the smallest-sized companies of ≤4 full-time equivalent employees. Unionisation was associated (positively) with the incidence of no-lost-time claims in a crude model, but not in an adjusted one (CRR=1.80, 95% CI 1.71 to 1.89; ARR=1.04, 95% CI 0.98 to 1.09).ConclusionsCompany unionisation was associated with a lower risk of lost-time workers’ compensation injury claims, corroborating a similar study from an earlier time period. The protective effect of unionisation declined as company size decreased. In contrast to the previous study, a positive relationship between company unionisation and no-lost-time claim incidence was not found, due in part to a methodological refinement.

INTRODUCTION:Long Term Care (LTC) facilities are fast-paced, demanding environments placing workers at significant risk for injuries. Health and safety interventions to address hazards in LTC are challenging to implement. The study assessed a participatory organizational change intervention implementation and impacts.METHODS:This was a mixed methods implementation study with a concurrent control, conducted from 2017 to 2019 in four non-profit LTC facilities in Ontario, Canada. Study participants were managers and frontline staff. Intervention sites implemented a participatory organizational change program, control sites distributed one-page health and safety pamphlets. Program impact data were collected via Survey (self-efficacy, control over work, pain and general health) and observation (Quick Exposure Checklist). Interviews/focus groups were used to collect program implementation data.RESULTS:Participants described program impacts (hazard controls through equipment purchase/modification, practice changes, and education/training) and positive changes in culture, communication and collaboration. There was a statistically significant difference in manager self-efficacy for musculoskeletal disorder (MSD) hazards between the control and intervention sites over time but no other statistical differences were found. Key program implementation challenges included LTC hazards, staff shortage/turnover, safety culture, staff time to participate, and communication. Facilitators included frontline staff involvement during implementation, management support, focusing on a single unit, training, and involving an external program facilitator.CONCLUSION:A participatory program can have positive impacts on identifying and reducing MSD hazards. Key to success is involving frontline staff in identifying hazards and creating solutions and management encouragement on a unit working together. High turnover rates, staffing shortages, and time constraints were barriers as they are for all organizational change efforts in LTC. The implementation findings are likely applicable in any jurisdiction. Practical Application: Implementing a participatory organizational change program to reduce MSD hazards is feasible in LTC and can improve communication and aid in identification and control of hazards.

Objective The effectiveness of a regulatory training standard to prevent falls from heights in construction in the province of Ontario, Canada was evaluated. The standard specifies a full day of working-at-heights safety training, including both theoretical and practical elements, delivered by a government-approved training provider. Once the regulatory requirements were in full effect in fall 2017, over 400,000 workers were trained to the standard. Methods A comprehensive effectiveness evaluation of the working-at-heights training standard was undertaken, including a longitudinal survey of over 600 workers who underwent the training, collection of their pre-post-training knowledge test scores, and a quasi-experimental analysis of lost-time injury claims for work disability insurance. Results A large increase in mean knowledge test score (out of 10 points) was observed for workers on their day of training: from 6.8 to 9.5 points (p Follow-up after two years, showed a large decline in knowledge test scores (to mean score 7.5). In contrast, the work practice improvements had been sustained. The incidence rate of lost-time claim injuries due to falls targeted by the training (e.g. falls from roofs) declined by 21.0% from 2012–2014 to 2017–2018 in the Ontario construction sector. In comparison, the rate due to falls not targeted by the training (e.g. falls at the same level) increased by 2.9%; and the rate due to non-fall traumatic injuries decreased by 7.3%. These differences in incidence rate changes were statistically significant. (Analyses are currently being updated to include injuries from 2019.) Conclusion The evaluation findings provide consistent support for a conclusion that the mandatory training standard was effective in reducing the incidence of injuries targeted by the training.

Introduction: A regulatory training standard for construction workers using fall protection equipment became mandatory in 2015 in the province of Ontario, Canada. By the end of the transition period in 2017, 418,000 workers had been trained to the new standard. Two primary research questions were posed: (1) To what extent does the WAH training affect practices at the worksite? and (2) Has there been a change in the incidence of fall-from-height injuries coincident with the introduction of the WAH Training Standard? Materials and methods: A longitudinal survey of 633 learners was conducted in 2017 at one-, four- and seven-week post-training. A quasi-experiment estimated the incidence of lost-time injuries attributed to falls from heights in 2017 compared to 2012-2014 for a census of construction workers insured for work disability in Ontario, Canada. Results: Learners self-reported substantial increases in knowledge of and improvements in safe work practices when working at heights. The incidence rate of lost-time claim injuries attributed to falls targeted by the training declined by 19.6% (95% CI: 10.7, -27.6), compared to corresponding declines of 2.1% (95% CI: -6.3, 9.9) for other fall injuries and 7.2% (95% CI: 1.8,12.3) for non-fall traumatic injuries. The observed decline was largest among the smallest employers (<5 full-time equivalent employees). Conclusion: The evaluation findings provide consistent support for a conclusion that the mandatory training standard was effective in reducing the incidence of injuries targeted by the training. However, the effects were modest and did not eliminate the problem. (C) 2020 National Safety Council and Elsevier Ltd. All rights reserved.

Purpose The purpose of this paper is to use a comparative qualitative case study design to better understand how the observed characteristics of an organization correspond to their score on the organizational performance metric (IWH-OPM), a leading indicator tool designed to measure an organization's occupational health and safety (OHS) performance. Design/methodology/approach Five organizations were recruited based on their diverse IWH-OPM scores obtained in a previous study. Qualitative data were collected from these cases and analyzed with consideration of OHS leadership; OHS culture and climate; employee participation in OHS; OHS policies, procedures and practices; and OHS risk control. Similarities and differences among organizations were examined in relation to these themes. Findings Three distinct groups of firms emerged from the cross-case analysis in terms of their overall OHS performance: high, medium and low. Higher firm IWH-OPM scores generally corresponded to better OHS performance in the workplace as observed through qualitative methods. Originality/value The findings are a step toward OHS leaders or practitioners eventually being able, based on an organization's IWH-OPM score, to have a quick understanding of a workplace's OHS status and of how best to support further improvement.

Introduction Violence in hospitals is a serious occupational health and safety (OHS) issue affecting the physical and mental health of front line staff, as well as, the quality of patient care. In 2010, the province of Ontario (Canada) introduced legislation that directs hospitals to put into place violence prevention and management systems. Our study examined how five Ontario hospitals have developed and implemented their violence prevention programs. Methods Semi structured interviews were conducted with eight key informants external to hospitals (legislators, union leaders, hospital associations), management and occupational health and safety specialists in hospitals (n=40), 21 focus groups (n=115) and interviews (n=6) with front line workers. Five hospitals participated in the study. Interview and focus group questions focused on the effect of the legislation on the development of violence prevention programs and how these were implemented across departments. Once data were collected, a code list was developed by the research team by reviewing the transcripts. Each transcript was coded by two researchers and then a thematic, inductive analysis was carried out. The constant comparative method was used to identify differences and similarities across hospitals and to understand factors that shape hospital policies and practices in the area of violence prevention and management. Findings Our study findings suggest that while legislation sets parameters for the development of policies, serious violence-related events and the presence of a violence prevention ‘champion’ bolster long-term commitment to violence prevention in hospitals and the development of sustainable programs. We discuss four key components related to the prevention and management of violence in hospitals, namely; security systems, patient ‘flagging’, codes and alarms and incident reporting. Discussion Our findings detail how management commitment, workplace culture and broader structural factors can shape the implementation of hospital policies around violence prevention and reporting. Study recommendations focus on the long-term sustainability of violence prevention practices in the acute care sector and the implications this can have on worker health.

This mixed-method research investigates the routines that enable a production system to be safe and operationally effective. We focus on the notion of a joint management system, a specific case of an integrated management system that encompasses safety and operations at the level of daily routines. We use a series of ten case studies to examine the content of joint management systems and offer detailed insight into the overlap in routines between safety management and operations management. The results detail the critical routines that such systems encompass. We then use a sample of 198 facilities to confirm that joint management systems are associated with this specific set of routines and show that these routines bundle together.

Employers are increasingly interested in offering workplace wellness programs in addition to occupational health and safety (OHS) activities to promote worker health, wellbeing, and productivity. Yet, there is a dearth of research on workplace factors that enable the implementation of OHS and wellness to inform the future integration of these activities in Canadian workplaces. This study explored workplace demographic factors associated with the co-implementation of OHS and wellness activities in a heterogenous sample of Canadian workplaces. Using a cross-sectional survey of 1285 workplaces from 2011 to 2014, latent profiles of co-occurrent OHS and wellness activities were identified, and multinomial logistic regression was used to assess associations between workplace demographic factors and the profiles. Most workplaces (84%) demonstrated little co-occurrence of OHS and wellness activities. Highest co-occurrence was associated with large workplaces (odds ratio (OR) = 3.22, 95% confidence interval (CI) = 1.15–5.89), in the electrical and utilities sector (OR = 5.57, 95% CI = 2.24–8.35), and a high people-oriented culture (OR = 4.70, 95% CI = 1.59–5.26). Promoting integrated OHS and wellness approaches in medium to large workplaces, in select industries, and emphasizing a people-oriented culture were found to be important factors for implementing OHS and wellness in Canadian organizations. Informed by these findings, future studies should understand the mechanisms to facilitate the integration of OHS and wellness in workplaces.

Introduction: OHS management audits are one means of obtaining data that may serve as leading indicators. The measurement properties of such data are therefore important. This study used data from Workwell audit program in Ontario, a Canadian province. The audit instrument consisted of 122 items related to 17 OHS management elements. The study sought answers regarding (a) the ability of audit-based scores to predict workers' compensation claims outcomes, (b) structural characteristics of the data in relation to the organization of the audit instrument, and (c) internal consistency of items within audit elements. Method: The sample consisted of audit and claims data from 1240 unique firms that had completed one or two OHS management audits during 2007-2010. Predictors derived from the audit results were used in multivariable negative binomial regression modeling of workers' compensation claims outcomes. Confirmatory factor analyses were used to examine the instrument's structural characteristics. Kuder-Richardson coefficients of internal consistency were calculated for each audit element. Results: The ability of audit scores to predict subsequent claims data could not be established. Factor analysis supported the audit instrument's element-based structure. KR-20 values were high (>= 0.83). Conclusions: The Workwell audit data display structural validity and high internal consistency, but not, to date, construct validity, since the audit scores are generally not predictive of subsequent firm claim experience. Audit scores should not be treated as leading indicators of workplace OHS performance without supporting empirical data. Practical applications: Analyses of the measurement properties of audit data can inform decisionmakers about the operation of an audit program, possible future directions in audit instrument development, and the appropriate use of audit data. In particular, decision-makers should be cautious in their use of audit scores as leading indicators, in the absence of supporting empirical data. (C) 2017 National Safety Council and Elsevier Ltd. All rights reserved.

BACKGROUND Concern regarding functioning and effectiveness of joint health and safety committees (JHSCs) in Ontario hospitals was raised following the Severe Acute Respiratory Syndrome outbreak in 2003. A subsequent literature review revealed a lack of studies focused within the healthcare sector. METHODS A tool to measure JHSC effectiveness was developed by a panel of occupational health and safety experts based on a framework from the healthcare sector. Usability testing was conducted in two phases with members of five hospital JHSCs before, during and after a committee meeting. RESULTS Usability of the tool was scored high overall with an average of > 4 on a 5 point scale across twelve items. Downward adjustment of self-assessment scores was reported following JHSC meetings. CONCLUSION Findings demonstrated that the tool was easy to use, effective in supporting discussion and in assisting participants in reaching consensus on rating a large number of JHSC characteristics. Am. J. Ind. Med. 60:368-376, 2017. © 2017 Wiley Periodicals, Inc.

This exploratory study sought to identify the factors important to large improvement in workplace occupational health and safety (OHS) performance. Mixed methods were used to systematically identify 12 organizations in a workers' compensation database that had made large and intentional improvement in workplace OHS performance in Ontario, Canada, during 1998-2008 (i.e., "breakthrough change" (BTC) cases). Four of these organizations were selected for in-depth case study (two manufacturers, a grocery and a social agency). Cross-case analysis and consideration of existing literature led to a 12-element conceptual model with organizational learning at its core. Four elements were involved in the initiation of BTC: external influence, organizational motivation to improve OHS, new OHS knowledge and a knowledge transformation leader. Five other elements were involved in the process of BTC: responsiveness to OHS concerns, positive social dynamics, continuous improvement pattern, simultaneous operational improvement, and supportive internal context. Finally, three elements are outcomes of BTC: integrated OHS knowledge, decreased OHS risk, and decreased injury and illness. These concepts can be used in future research regarding workplace improvement in OHS performance. (C) 2016 The Authors. Published by Elsevier Ltd.

OBJECTIVE:The aim of this study was to determine whether management system practices directed at both occupational health and safety (OHS) and operations (joint management system [JMS] practices) result in better outcomes in both areas than in alternative practices.METHODS:Separate regressions were estimated for OHS and operational outcomes using data from a survey along with administrative records on injuries and illnesses.RESULTS:Organizations with JMS practices had better operational and safety outcomes than organizations without these practices. They had similar OHS outcomes as those with operations-weak practices, and in some cases, better outcomes than organizations with safety-weak practices. They had similar operational outcomes as those with safety-weak practices, and better outcomes than those with operations-weak practices.CONCLUSIONS:Safety and operations appear complementary in organizations with JMS practices in that there is no penalty for either safety or operational outcomes.

OCCUPATIONAL APPLICATIONS Despite many biomechanical risk factors being clearly linked to the development of musculoskeletal disorders, little measurement of the prevalence of physical loads in workplaces is being conducted. Through a collaborative partnership with unions, a health and safety organization, and researchers, this project developed and tested a questionnaire to document exposures to physical workloads in workplaces. Surveys were first completed independently by two members of each organization's joint health and safety committee. The same survey was later completed collectively to arrive at a consensus between the two members. Results of the surveys were then compared to findings from a walk-through conducted by an ergonomist. Substantial to excellent agreement was found between the identification and assessment of exposure levels to 26 types of physical loading by the ergonomist and workplace. Such a survey could be an efficient technique to characterize the loads to which workers are exposed. Such data could have value for targeting prevention activities at a workplace or jurisdictional level.TECHNICAL ABSTRACT Background: The presence and level of exposure to mechanical risk factors can be considered leading indicators in the development of musculoskeletal disorders. Although there are multiple methods for musculoskeletal disorder risk assessment, most of these methods record data related to an individual person performing a specific task. Rather in this questionnaire, we are collecting the exposure data at the workplace level (i.e., for all people experiencing this type of load). Purpose: The aim of this study was to develop and test a survey to document the presence and levels of multiple types of physical loading in a workplace. Methods: A survey requesting information on exposure to 26 types of loading was developed. It was distributed to management and worker representatives for their individual and then their consensus ratings. The same survey was completed by an ergonomist during a site visit. Results: Complete data sets were obtained from 30 workplaces across a variety of sectors. The most prevalent loads reported were sitting, neck bent or twisted, computer use, and carrying loads. For the presence or absence of specific loads, the consensus and ergonomist's ratings agreed well with over 90% for nine of 26 load types and over 70% agreement for 10 other load types. For a calculated exposure index, only four load types differed significantly across the two types of raters. Conclusions: The study demonstrates that a survey completed by individuals familiar with the workplace could be used to document exposure to physical loading at a workplace level in an efficient manner. Such a survey may be useful in understanding the nature and prevalence of such exposures and targeting prevention activities at a workplace or jurisdictional level.