To Counteract Fatigue, it is Important be Familiar with Some of its Main Causes and Symptoms.

Common Causes of Fatigue

1. Sleep deprivation: Not getting enough sleep is probably the most common cause of fatigue. It’s important to keep in mind that there are different reasons for being sleep deprived, including:

• Extended time awake. How long has it been since you slept? After being awake for 16 consecutive hours most people begin to feel tired.
• Reduced time asleep. Most people need between 7-9 hours of sleep to be at their best.  
• Disrupted or poor quality sleep. Whether it’s a baby waking you up every 2 hours or back pain that prevents you from getting comfortable, not getting good quality sleep can lead to sleep deprivation.
• The cumulative effect of multiple days with shortened or disrupted sleep – Has it been a couple of days since you last slept well? This type of sleep deprivation could put you at greater risk for feeling fatigued. 

The simple answer is yes. Here's why:

1. Your workers are not machines – they are humans.

2. Humans aren’t designed to work outside of our “operating limitations”

3. Once our human operating limitations have been reached, we are at an escalated risk for errors, accidents and productivity losses.

4. The outcomes of human errors and accidents can be catastrophic.

As Dr. Martin Moore-Ede stated in his book, The Twenty-Four-Hour Society, “People don’t release smoke, grind gears, or have pieces fall off; but their equivalents – fatigue, error, injury, and ill health – do result in failure and breakdown."

Reason’s Approach

James Reason, a distinguished professor and author, developed the ‘Swiss Cheese Model of Accident Causation’ to illustrate that although multiple layers of defense lie between hazards and accidents, flaws, or ‘holes’, can exist in each layer. When these “holes” align, a pathway accidents emerges (Figure 1).

Given the nature of operational defenses, holes in the defense layers are dynamic and constantly opening, closing, and shifting within an organization – requiring an organization to continually re-evaluate the integrity of their defense systems.

When applying Reason’s logic to fatigue management, a fatigue-related accident or incident is the end point of a causal chain of successive lapses in a defense system. Therefore, an organization is responsible for developing a comprehensive defense system against fatigue; while its employees are responsible for arriving to work alert and fit-for-duty.

Applying Reason’s Logic to Fatigue Risk Management Systems

Reason’s Swiss Cheese Model of Defense was used to develop the model for comprehensive fatigue risk management systems (FRMS), which is now the international standard for managing and mitigating fatigue in operations (Figure 2).

Interestingly, fatigue has a global cost to employers of over $100 billion per year, yet CIRCADIAN surveys reveal that only 10% of organizations have implemented a comprehensive fatigue risk management system. ^1-2

This means that despite the overwhelming evidence that an FRMS is necessary for optimizing the safety and profitability of an operation, many organizations are choosing to forgo implementing these critical systems. But why?

Some would suggest that this counterintuitive behavior is a result of our optimism bias.

The Dangerous Optimism Bias

Optimism bias is a cognitive bias that causes a person to believe that he or she has a lower risk of experiencing a negative event compared to others.

When applied to operations management, the optimism bias can prevent managers from implementing the safety measures necessary to prevent a fatigue-related accident.

So how do you overcome this bias to ensure the safety of your operation?

Overcoming the Optimism Bias

To overcome the optimism bias, start by asking yourself the following key questions:

1. Is your operation understaffed?

2. Is your workforce’s overtime rate (actual weekly hours worked/scheduled weekly hours) consistently above 12 percent?

3. Do a few key employees work most of the available overtime?

4. Do your workers complain about the shifts they work?

5. Is there a high degree of shift swapping among your workers?

6. Are your workers exhibiting any of the common symptoms of fatigue? Have workers mentioned being tired or struggling with fatigue?

7. If you run 8-hour shifts, are your workers allowed to work more than 7 days in a row? If you run 12-hour shifts, are your workers allowed to work more than 5 days in a row?

8. Does your operation experience high rates of absenteeism and/or turnover?

9. Do more accidents and injuries occur on night and weekend shifts as compared to day shifts during the work week? Have you been experiencing higher rates of accidents/injuries in general?

10. Does your operation have excessive workers’ compensation claims?

If you answered yes…

If you answered yes to any of these questions, you should consider having a conversation with an expert to determine if your operation is facing serious challenges to its overall safety. If you answered yes to more than one of these questions, you should talk with an expert.

At this point, you may be telling yourself that now isn't the right time for that conversation – maybe later, next quarter, next promotion. Whatever it is that you're telling yourself to validate your procrastination – stop. Take the first step towards a safer operation – right now.

It’s easy to fall prey to optimism bias, however, disasters like Chernobyl, Three-Mile Island, and the 2005 Texas City Explosion are solemn reminders that fatigued workers can inadvertently make poor decisions at any moment that can result in grave consequences.

History tells the unfortunate tale of too many operations that chose to ignore worker fatigue and suffered catastrophic destruction, sky-high costs and even loss of life.

Clearly it’s time to make fatigue management a priority, if you haven’t done so already.

Workforces that have implemented a comprehensive FRM benefit from improvements in worker productivity, absenteeism, turnover and excessive overtime – along with many other added benefits.

These systems often accrue significant ROIs for companies, as was the case with Dupre’ Logistics (see below).

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Sleep deprivation is an issue that is often ignored, yet frequently the root cause of decreased productivity, accidents, incidents and mistakes which costs the global workforce billions of dollars each year.

Often times, managers and supervisors misattribute fatigue-related operational errors as isolated events caused by a single individual, rather than a systematic failure. Other times, increased accident rates and workforce problems are dismissed as being unrelated to worker fatigue.

Using logic presented by James Reason, a distinguished professor of psychology at The University of Manchester and author of many important books, including Human Error (1990), we can better understand the root cause of fatigue-related errors.

Analyzing Fatigue-Related Errors with Reason

James Reason proposed two possible approaches to the problem of human error: the person approach and the system approach.

The person approach focuses on the premise that an error is caused by a single individual, whether it be due to forgetfulness, inattention, negligence, and other personal lapses.

The system approach focuses on the premise that humans are fallible and errors are to be expected; therefore, errors are consequences of systematic failures and the root cause of errors ultimately falls on the system rather than the individual.

Reason developed the Swiss cheese model of accident causation to illustrate that although multiple layers of defense lie between hazards and accidents, flaws, or ‘holes’, can exist in each layer. When these “holes” align, a pathway emerges for accidents to occur (Figure 1).

Figure 1. James Reason’s Swiss Cheese Model

Given the nature of operational defenses, holes in the defense layers are dynamic and constantly opening, closing, and shifting within an organization – requiring an organization to continually re-evaluate the integrity of their defense systems.

Using Reason’s logic, operational control should be focused on changing the conditions under which individuals work rather than trying to change each individual. Under this model, incident investigation should focus not on who made an error, but rather how and why the systematic defenses failed to prevent the incident.

The How and Why of Human Error

Holes in the defense layers arise from two outcomes: active failures and latent conditions. Active failures are the dangerous acts of individuals – such as: lapses, errors, or procedural deviations. The impact of active failures on the integrity of a defense system are usually temporary.

Latent conditions are the result of decisions made by the management team of an organization. These decisions may lead to unfavorable conditions – such as understaffing and excessive overtime – that can lead to long-lasting weaknesses in the defenses (i.e. fatigued workers, unworkable procedures). Latent conditions can go unnoticed or ignored for many years, even though latent conditions are generally easier to identify and rectify than active failures.

Applying the Swiss Cheese Model to Fatigue Management

When applying Reason’s logic to fatigue management, a fatigue-related accident or incident is the end point of a causal chain of successive lapses in a defense system.

At the end of the day, both an organization and its employees share a responsibility to prevent fatigue to maintain a safe operation.

An organization is responsible for developing a comprehensive defense system against fatigue; while its employees are responsible for arriving to work alert and fit-for-duty.

Developing an Effective Fatigue Risk Management System

A fatigue risk management system (FRMS) is a data-driven, risk-informed, safety performance-based program that reduces the risk of fatigue-related incidents in 24/7 operations. An FRMS continually monitors and reduces fatigue risk from both an organizational and individual approach.

An effective FRMS builds upon organizational policies and procedures to monitor, mitigate, and report worker fatigue and fatigue-related incidences.

When developing or reviewing an FRMS, an opportunity exists to identify the presence (or absence) of necessary defense mechanisms in the FRMS. A fully integrated FRMS provides five equally-critical layers of defense (Figure 2):

1. Workload-staffing balance
2. Shift schedule optimization
3. Employee fatigue training and sleep disorder management
4. Workplace environmental design
5. Fatigue monitoring and alertness for duty

Figure 2. CIRCADIAN® 5 Defenses FRMS Design

A successful FRMS also has the following seven key characteristics (Lerman et al.):

1. Science based – Supported by established peer-reviewed science

2. Data driven – Decisions based on collection and objective analysis of data

3. Cooperative -- Designed together by all stakeholders

4. Fully Implemented – System-wide use of tools, systems, policies, procedures

5. Integrated -- Built into the corporate safety & health management systems

6. Continuously improved – Progressively reduces risk using feedback, evaluation & modification

7. Owned – Responsibility accepted by the entire management team of an organization

The seventh key characteristic, management ownership, is particularly critical as the development, implementation, and management of a FRMS requires the involvement of multiple departments of an organization.

Because of this, it’s important that the entire management team of an organization embraces a commitment to fatigue risk management as a critical component to the organization's overall safety and health management system.

Through properly implementing a comprehensive FRMS, an organization stands to significantly reduce the safety risks and profit losses associated with fatigue in a way that provides a win-win scenario for both management and workers.

White Paper: Evolution of Fatigue Risk Management Systems

Download your copy of our white paper “Evolution of Fatigue Risk Management: The “Tipping Point” of Employee Fatigue Mitigation” to learn more about implementing operational defenses against fatigue.

About CIRCADIAN®

CIRCADIAN® is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock. Through a unique combination of consulting expertise, research and technology, software tools and informative publications, CIRCADIAN helps organizations in the 24-hour economy optimize employee performance and reduce the inherent risks and costs of their extended hours operations.

Myth #1 – Overtime within your workforce is evenly distributed

Best practices suggest that when overtime is equally distributed across a workforce, up to approximately 12% overtime is an acceptable rate. However, overtime rates vary across industries, companies and employees.

Research indicates that in many industries, 20% of employees work 60% or more of the overtime (Figure 4).¹

Figure 4. Actual distribution of overtime at an extended hours facility.¹

Since accidents and safety problems can be caused by one fatigued employee, the risk of an accident occurring can rise as the distribution of overtime becomes increasingly skewed.

The imbalance exposes the pool of high overtime employees to extra health risks, and exposes the company to increased absenteeism costs, health care costs, safety issues, and legal liability.

Myth #2 – Employee productivity increases linearly

Studies and reports suggest that productivity can suffer with increased overtime hours.

Data from 18 manufacturing industries in the U.S. shows that for most of these industries, productivity (measured as output per hour) declines when overtime is used.²

On average, a 10% increase in overtime results in a 2.4% decrease in productivity (more output is achieved, but the number of hours worked increases as well—not as much output per hour is realized).

This performance decline is confirmed by the work of J. Nevison of Oak Associates. In his white paper, Nevison brings together scientific, business, and government data to demonstrate that little productive work takes place over and above 50 hours per week (Figure 2)³. Two other studies, also examined in the white paper, show that productive hours drop by an additional 10 hours when the number of consecutive long workweeks increases from four to 12, highlighting the cumulative effects that overtime can have on productivity.

Figure 2. Productive vs. actual work hours, from a collection of four studies⁴

Myth #3 – Adequate staffing means having enough employees to cover permanent positions

Often overlooked are the real drivers of overtime in 24/7 operations. In any given week, employees may not be available to fill their scheduled shifts because of multiple reasons including:

• Vacation days
• Floating holidays
• Sickness related absenteeism
• Non-sickness related absenteeism/personal days
• Injury-related absenteeism
• Training
• Special work assignments (committees, team building, projects, etc.)
• Jury duty, bereavement, FMLA, etc.
• Turnover/delays in filling position with adequately trained employees

Many 24/7 operations do not realistically estimate or measure the full impact of these factors and hence run their shifts with fewer staff than needed, effectively increasing the relief coverage requirement (i.e. overtime) and impacting the time on duty and off duty of their personnel.

Furthermore, many companies do not monitor and analyze their historical payroll and human resources data so that they are unable to make even simple forecasts about scheduled and unscheduled absenteeism. Without this data, they are unable to accurately define seasonal, weekly and daily fluctuations in coverage demand.

Based on CIRCADIAN's 2014 Shiftwork Practices data, we found that the "leaner" operations (i.e. reduced staffing levels) reported higher absenteeism rates (Figure 1).

Interestingly, over 50% of all unscheduled absences are due to either: personal needs, stress, or an entitlement mentality (i.e. “I’ve earned it”).⁵

Myth #4 – Operational decisions on shift scheduling are best if mandated by management.

Management-mandated work schedules often prevent an operation from reaching its full potential in terms of operational costs, productivity, efficiency, and safety.

Employee participation is just as important in the process of designing and implementing the new work schedule as the characteristics of the new work schedule itself.^6-9

Surveys suggest that management-mandated work schedules can lead to:¹⁰

• Increased absenteeism
• Excessive overtime costs
• Increased health problems and fatigue
• Decreased morale
• Increased turnover costs
• Recruitment problems

Studies comparing methods of shift schedule selection have found that employee involvement in schedule redesign increases the benefits of schedule redesign considerably, as compared to management-mandated schedule changes. These benefits include:^11-18

• Increased worker satisfaction with schedule design
• Decreased unscheduled absences from illness
• Improved physical and psychological vigor
• Decreased turnover and number of vacant positions
• Increased organizational commitment
• Improved employee and management relations

Myth #5 – If a shift schedule works well at our other plant, it will work for us here.

This is a common misconception in companies with multiple facility locations. A shift schedule that’s effective and well-liked at one facility can cause disagreements and tension among workers at a seemingly identical facility.

Shift schedules need to be based on the social, operational and physiological needs of the workforce and managers at each specific company site. Some factors to consider include:

• Geographic location
• The lifestyles of workers
• Cultural differences
• Worker demographics

These factors can greatly impact the popularity of different shift schedules among workers. For example, avoiding rush hour traffic is often important to workers in large cities, whereas workers in rural areas might prefer longer spans of days off.

Best shift scheduling practices suggest choosing a schedule with features that support the priorities of workers at each individual facility.

Pleasing everyone may be impossible, but having the majority of workers in favor of a new shift schedule will greatly increase the likelihood of a successful schedule change.

Myth #6 – Given the choice, workers always select the best schedule for them and the worst for the company.

Much conflict between management and shiftworkers is the result of misunderstanding and poor communication.

Management often feels that it is doing its part by “telling,” rather than both telling and listening to the needs of workers. Workers may feel that they’re providing valuable insight, but management only hears the complaints. As a result, management may feel that workers only care about themselves and making money.

While the occasional worker may try to game the system, most workers are truly concerned with the well-being of the company. After all, workers realize that any problem that the company faces will ultimately affect them. In light of this, most workers will choose a schedule that will satisfy the company while still fulfilling their individual needs.

The best way to ensure that workers understand the reasons for making any scheduling changes is by keeping them informed. This can be accomplished through company-wide meetings or events, as well as through regular emails or letters about the general state of the company.

Myth #7 – Falling asleep on the job is a matter of willpower

While curling up with a pillow and blanket at work is clearly deliberate, many fatigued individuals unknowingly experience microsleeps while working. A microsleep is a brief sleep episode that lasts up to 30 seconds, during which a person temporarily loses consciousness and external stimuli aren’t perceived.¹⁹

Individuals who experience microsleeps are often unaware that they briefly lost consciousness and will frequently deny that they fell asleep.²⁰ When an individual arouses from a microsleep episode, it may feel like a brief lapse in attention or mind wandering.

Research suggests that even individual neurons can experience microsleeps, which means that your parts of the brain may be “offline” even if you’re seemingly awake.²¹

Microsleeps are most commonly associated with sleep deprivation and driving; however, microsleeps can also occur in the absence of sleep deprivation when completing monotonous, repetitive tasks.

Myth #8 – Napping during work is a lazy and unacceptable behavior

Before you write off napping as a leisurely activity that should be banned at work, you might want to consider the ways in which napping at your workplace can improve the alertness and productivity of workers.

Ten minute power naps provide immediate benefits upon awakening and boosts in performance that can last up to 4 hours!

Ten minute naps have been shown to: decrease fatigue, increase vigor, improve performance, improve communication, decrease blood pressure, improve reaction time, improve subject well-being, and increase alertness.

Longer naps that last 90 minutes (or longer) still offer many restorative benefits; however, they are not as efficient as power naps. Longer naps allow for memory consolidation and therefore have been shown to improve memory. Extended napping is frequently associated with profound sleep inertia, which can be crippling to productivity. In order to avoid the sleep inertia of long naps, it's advised to sleep a full 90 min sleep cycle in order to wake up at the lightest sleep stage.

Myth # 9 – Hours of service requirements are sufficient for mitigating employee fatigue

Most fatigue regulations start and end with hours of service policies. While this is a good starting place, it fails to address all of the factors that contribute to fatigue. To ensure the alertness of workers, a comprehensive fatigue risk management system (FRMS) needs to be in place.

A fatigue risk management system (FRMS) is a data-driven, risk-informed, safety performance-based program that reduces the risk of fatigue-related incidents in 24/7 operations. An FRMS will continually monitor and reduce fatigue risk.

Workforces that have implemented fatigue risk management systems experience fewer problems with absenteeism, turnover and excessive overtime. Employees in these workforces have greater morale, less stress, and are more productive workers.

Myth #10 – There’s very little financial ROI with fatigue risk management

To some, fatigue might seem like a minor concern, yet it costs companies millions of dollars each year in excess costs, accidents and errors.

Fatigued workers cost employers $136.4 billion annually in health-related lost productive time (absenteeism and presenteeism), almost 4x more than their non-fatigued counterparts.²²

Fatigued workers exhibit up to 4x the worker’s compensation costs as compared to non-fatigued workers (Figure 3).²⁴ A recent meta-analysis of 27 observational studies found that sleep problems increase the risk of workplace injuries by 62 percent.²³

Addressing and mitigating fatigue within an operation can significantly decrease excess costs related to: absenteeism, turnover, accidents, and healthcare.

 

Debunk Other Shift Work Myths

Explore the variety of CIRCADIAN white papers that cover an assortment of 24/7 workforce topics including:

• Shift Scheduling
• Staffing Levels
• Fatigue Risk Management Systems
• Shiftwork Lifestyle Training
• And much more!

 

REFERENCES

1. CIRCADIAN databases
2. Shepard E, Clifton T. Are Long Hours Reducing Productivity in Manufacturing. International Journal of Manpower 2000; 7.
3. Nevison, J. Overtime Hours: The Rule of Fifty
4. Permission from Nevison, Oak Associates.
5. CIRCADIAN. 2014 Shiftwork Practices.
6. Hauburger. Implementation of self-scheduling in the poison center. Vet. Hum. Toxicol. 39(3),175-7. 1997.
7. Knauth P.The design of shift systems. Ergonomics 36(1-3),15-28. 1993.
8. Knauth P. Changing schedules: shiftwork. Chronobiol. Int. 14(2),159-71. 1997.
9. Kogi K, Di Martino VG. Trends in participatory process of changing shiftwork arrangements. Work & Stress 9 (2/3), 298-304. 1995.
10. Circadian Technologies, Shiftwork Practices Survey 2002.
11. Ala-Mursula et al. Employee control over working times: associations with subjective health and sickness absences. J. Epidemiol. Community Health 56(4),272-8. 2002.
12. Beltzhoover M. Self-scheduling: an innovative approach. Nurs. Manage. 25(4),81-2. 1994.
13. Bradley, Martin. Continuous personnel scheduling algorithms: a literature review. J. Soc. Health Syst. 2(2),8-23. 1991.
14. Holtom et al. The relationship between work status congruence and work-related attitudes and behaviors. J. Appl. Psychol. 87(5),903-15. 2002.
15. Moore-Ede M. The Twenty-Four Hour Society: Understanding Human Limits in a World that Never Sleeps. 1994.
16. Smith PA et al. Change from slowly rotating 8-hour shifts to rapidly rotating 8-hour and 12-hour shifts using participative shift roster design. Scand. J. Work Environ. Health. 24(S3), 55-61. 1998.
17. Teahan. Implementation of a self-scheduling system: a solution to more than just schedules! J. Nurs. Manag. 6(6),361- 81. 998. Erratum in: J. Nurs. Manag. 7(1),65. 1999.
18. Sakai K et al. Educational and intervention strategies for improving a shift system: an experience in a disabled persons' facility. Ergonomics 36(1-3),219-25. 1993.
19. International Classification of Sleep Disorders Diagnostic and Coding Manual, http://www.esst.org/adds/ICSD.pdf, page 343.
20. Higgins, Laura; Fette Bernie (in press). "Drowsy Driving" (PDF). Retrieved 2013-06-12.
21. Vyazovskiy, V. V., Olcese, U., Hanlon, E. C., Nir, Y., Cirelli, C., & Tononi, G. (2011). Local sleep in awake rats. Nature, 472(7344), 443-447.
22. Ricci, J. A., Chee, E., Lorandeau, A. L., & Berger, J. (2007). Fatigue in the US workforce: prevalence and implications for lost productive work time. Journal of Occupational and Environmental Medicine, 49(1), 1-10.
23. Katrin Uehli, Amar J. Mehta, David Miedinger, Kerstin Hug, Christian Schindler, Edith Holsboer-Trachsler, Jörg D. Leuppi, et al. (2014). Sleep problems and work injuries: A systematic review and meta-analysis. Sleep Medicine Reviews. doi:10.1016/j.smrv.2013.01.004
24. Aguirre, A. Shiftwork Practices Survey, 2005.

In September, the American Nurses Association released a position statement regarding nurse fatigue. According to the ANA, both registered nurses and employers have a joint responsibility to “reduce risks from nurse fatigue and to create and sustain a culture of safety, a healthy work environment, and a work-life balance.”

The ANA also stated that "registered nurses and employers have an ethical responsibility to carefully consider the need for adequate rest and sleep when deciding whether to offer or accept work assignments, including on-call, voluntary, or mandatory overtime.”

Here are five reasons why you should prioritize nurse fatigue management:

1. The Prevalence of Fatigue Among Nurses

An abundance of research data on nursing fatigue exists to support the conclusion that fatigue is a serious concern for the healthcare industry.

Compared to the 7-8 hours of sleep required for optimal alertness and performance, it’s sobering that 80% of nurses get less than 6 hours of sleep prior to working a shift and 55% of nurses report that they “almost always” or “all of the time” felt fatigued during work (Scott et al., 2007; Geiger-Brown et al., 2012; Canadian Nurses Association & Registered Nurses Association, 2010).

2. High Injury Rates Among Healthcare Workers

According to the Occupational Safety & Health Association (OSHA), the healthcare and social assistance industry reported more injury and illness cases than any other private industry sector in 2011.

Fatigued workers exhibit up to 4x the workers compensation costs of non-fatigued workers, as shown in Figure 1 (CIRCADIAN, 2005).

Between 2006 and 2011, the average workers’ compensation claim for a hospital injury was found to be $15,860 among the roughly 1,000 hospitals surveyed (Aon Risk Solutions, 2012).

Figure 1. Workers Compensation Claims & Fatigue Levels

3. High Turnover Rates & United States Nursing Shortage

There is a nursing shortages as a significant segment of the nursing workforce is nearing retirement. Experts project that more than 1 million nurses will reach retirement age in the next 10 to 15 years. This poses a major concern for members of the healthcare industry, as nursing school enrollment rates have been on a steady decline. Because of these factors, it’s become increasingly important for healthcare systems to retain nurses.

It’s no secret that high turnover rates are having serious implications on the healthcare industry, as a national survey of home healthcare agencies reported a 21% turnover rate for registered nurses (Hospital and Healthcare Compensation Services, 2000).

Interestingly, turnover rates are found to be significantly higher in workforces experiencing employee fatigue and stress problems, as seen in Figure 2 (CIRCADIAN, 2005).

Figure 2. Association between Turnover Rates and Fatigue and Stress Levels

Replacing a nurse’s position has been estimated to cost an employer between $27,000 and $103,000 (Li & Jones, 2012). Given the high cost, fatigue risk management can be a cost-effective approach for reducing the high turnover rate among nurses.

4. Overtime & Workplace Injuries

Research looking at 110,326 U.S. job records revealed that working in jobs with overtime schedules was associated with a 61% higher injury hazard rate as compared to jobs without overtime. Working at least 12 hours per day was associated with a 37% higher injury hazard rate and working at least 60 hours per week was associated with a 23% increased hazard rate (Dembe, Erickson, & Banks, 2005).

These findings may not even account for all workplace injuries. One study found that 24% of nurses and nursing assistants changed shifts or took sick leave to recover from an unreported injury (Siddharthan, Hodgson, Rosenberg, Haiduven, & Nelson, 2006).

5. Joint Commission Statement on Fatigue

In December 2011, the Joint Commission, which accredits more than 20,000 U.S. healthcare organizations, recommended that healthcare organizations “create and implement a fatigue management plan.”

According to the Joint Commission’s Sentinel Event Alert, Health Care Worker Fatigue and Patient Safety, “There are now some evidence-based actions that healthcare organizations can take to help mitigate the risk of fatigue that results from the extended work hours – and, therefore, protect patients from preventable adverse outcomes.”

Commitment to Care

The mission statement of most healthcare organizations highlights the organization’s commitment to excellence in providing health care, patient safety, and improving the well-being of their local community.

A commitment to excellence is only truly upheld when an organization employs all possible measures to ensure unsurpassed patient care and safety. This means addressing workforce problems that impact the individual care providers, as these issues can have a domino effect that negatively impacts the quality of patient care.

If your organization isn’t addressing and managing the fatigue of the care providers, then scientific research suggests that your organization will suffer lapses in its commitment to superior patient care.

Solutions for Nurse Fatigue

To learn more about solutions for addressing, mitigating and managing nurse fatigue, download our white paper titled “Fatigued Nurses: Assessing the Risk, Implementing the Defenses”

About CIRCADIAN®

CIRCADIAN® is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock. Through a unique combination of consulting expertise, research, software tools and informative publications, CIRCADIAN helps organizations in 24/7 workforces optimize employee performance and reduce the inherent risks and costs of their extended hours operations.

REFERENCES

Aon Risk Solutions (2012). Health Care Workers Compensation Barometer.

Canadian Nurses Association & Registered Nurses’ Association of Ontario (2010): Nurse fatigue and patient safety research report. http://www.arnpei.ca/images/documents/ Fatigue_Safety_2010_EX%20Summary_e.pdf (retrieved February 22, 2013).

CIRCADIAN (2004). Shiftwork Practices 2004.

CIRCADIAN (2005). Shiftwork Practices 2005.

CIRCADIAN (2007). Shiftwork Practices 2007.

CIRCADIAN (2014). Shiftwork Practices 2014.

Geiger-Brown J et al. (2012): Sleep, sleepiness, fatigue, and performance of 12-hour-shift nurses. Chronobiology International 29(2): 211-219.

Hospital and Healthcare Compensation Services, Homecare Salary & Benefits Report, 2000-2001. Oakland, NJ: Hospital & Healthcare Compensation Service, 2000.

The Joint Commission (2011). Health care worker fatigue and patient safety. Sentinel Event Alert. 48.

Li , Y., & Jones, C.B. (2012). A literature review of nursing turnover costs. Journal of Nursing Management. 21(3): 405-418. (Dollar amounts presented here are adjusted to 2013 prices.

Siddharthan, K., Hodgson M., Rosenberg D., Haiduven D., and Nelson, A. (2006). Under-reporting of work-related musculoskeletal disorders in the Veterans Administration. International Journal of Health Care Quality Assurance. 19(6): 463-476

 

 

Why is fatigue mitigation critical for control room operators?

Control room operators across various industries are responsible for monitoring and maintaining systems that can that influence the safety of a workforce.

They are required to be attentive for extended periods of time, detect subtle changes in systems, respond quickly to safety threats and other incidents, and maintain communication with various workforce crews – just to name a few job responsibilities.

Based on the known switches of human alertness, the nature of the control room environment and complex job requirements can increase the likelihood of a fatigued operator falling asleep on the job.

Clearly, this could have devastating consequences – which validates the need for federal regulations on maximum hours of service, employee fatigue training, and workload assessment for control room operations.

Yet how does a fatigued control room operator threaten the integrity and safety of an operation beyond lapses in attention due to fatigue?

Imagine this scenario…

A control room operator shows up for the night shift feeling fatigued. In a sleep-deprived state, the operator struggles to remain alert and attentive to the many computer monitors reporting back that things are running smoothly. The calming hum of the computers acts as a lullaby to the fatigued operator, who can’t help but to feel sleepy in the dimly-lit control room. It’s almost as if the room was designed to put the operator to sleep.

The sleep-deprived operator is having trouble with maintaining focus on relevant cues, developing and updating strategies based on new information, keeping track of events, and attending to activities judged to be non-essential.

The operator eventually falls into a state known as “automatic behavior syndrome”, in which he or she looks to be attentive and responsive, but is unable to respond to changes in the system or maintain situational awareness.

Out of nowhere, a situation arises. A pipeline is under abnormally high pressure after the operator fails to respond to a pressure change in one of the gauges. The operator switches into high-alert mode, but the cognitive declines associated with fatigue linger.

The fatigued operator is slow to assess the situation and struggles to draw upon previous training to develop a solution. The operator makes a unilateral decision to proceed with a risky strategy for fixing the pipeline. The crew cautions the operator that safer, more effective options exist; however, the operator chooses to continue with the risky strategy.

In a distressed and cognitive impaired state, the operator fails to communicate several key details to crews trying to fix the problem. The pipeline ruptures, resulting in devastating damage to the environment and costly fines to the company.

 

This is reality of worker fatigue.

This hypothetical scenario has been an unfortunate reality in too many situations.

In fact, worker fatigue was found to be a contributing factor in the infamous 1986 Chernobyl disaster, where disastrous decisions were made by control room operators working long night shifts.

Fatigue-related error was deemed a contributing factor to the 1986 Chernobyl Disaster. (Image from boston.com)

Disasters like Chernobyl, Three-Mile Island, and the 2005 Texas City Explosion are solemn reminders that fatigued control room operators can inadvertently make poor decisions that can have grave consequences.

For these reasons, it makes perfect sense as to why fatigue management should be a priority for operators, facility managers, and all 24/7 industries.

Most fatigue regulations start and end with hours of service policies. While this is a good starting place, it fails to address all of the factors that contribute to fatigue, such as control room design. To ensure the alertness of workers, a comprehensive fatigue risk management system (FRMS) needs to be in place.

CIRCADIAN® 5 Defenses FRMS Design

Learn more about Fatigue Risk Management Systems

Download our white paper, “Evolution of Fatigue Risk Management Systems”, to learn more about the development of fatigue risk management systems and the CIRCADIAN® 5 Defenses FRMS Design.

Download our White Paper

 

About CIRCADIAN®

CIRCADIAN® is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock.  Through a unique combination of consulting expertise, research, software tools and informative publications, CIRCADIAN helps organizations in 24/7 workforces optimize employee performance and reduce the inherent risks and costs of their extended hours operations.

 

 

Worker fatigue may be an issue in your operation – whether you're aware of  it or not.

One-third (33%) of workforce managers believe that fatigue is a moderate or severe problem among their workers.¹

However, managing the risks associated with fatigue can be challenging. Serious concerns arise when workers don’t obtain sufficient rest between shifts, which can be due to worker’s behavioral choices, underlying sleep disorders and also due to management decisions (e.g. work schedules and staffing levels).

To some, fatigue might seem like a minor concern, yet it costs companies millions of dollars each year in excess costs, accidents and errors.

Fatigued workers cost employers $136.4 billion annually in health-related lost productive time (absenteeism and presenteeism), almost 4x more than their non-fatigued counterparts.²

Below are six types of excess costs to an operation that are often inflated by the repercussions of worker fatigue. If you are struggling to reduce these operational costs, you may be experiencing the “Iceberg Effect” of fatigue.

1. Absenteeism

Absenteeism alone accou

nts for as much as $2,660 in additional costs per year for shift workers as compared to day workers.¹

According to 2014 Shiftwork Practices data, only 50% of absences are due to personal illness and family issues, and almost 25% of absences are due to stress and feelings of entitlement.³

2. Compliance-related violations

Sleep deprived individuals have been shown to have trouble with maintaining focus, keeping track of events, maintaining interest in outcomes and attending to activities judged to be non-essential.⁴

In fact, research suggests that there is a interaction between sleep deprivation and attention-deficit hyperactivity disorder (ADHD) in which sleep deprivation exacerbates the symptoms of ADHD.⁵

This means that workers are at a much greater risk of having an oversight that could result in a compliance violation.

3. Lost Productivity

 When sleep deprived, individuals experience performance degradations such as: increased exerted effort to complete tasks, decreased vigilance and slower response time. The average functional level of any sleep deprived individual is comparable to the 9^th percentile of non-sleep deprived individuals.⁴

What is the cost of this lowered productivity? The total annual cost of lost productive time attributed to fatigue in the U.S. workforce has been estimated at $330 million, with 84% of this lost productive time due to reduced performance at work, as opposed to absenteeism.²

4. Increased Errors

When sleep deprived or fatigued, cognitive declines increase concurrently with a worker’s time on a given task, resulting in an increased number of errors. These errors include mistakes of both commission (i.e. performing an act that leads to harm) and omission (i.e. not performing an expected task), which can be disaster for any operation.⁴

Because of the cognitive slowing that occurs when tired, errors are especially likely in individual-paced and time-sensitive tasks.⁴

5. Overtime

When absenteeism rates are high, relief coverage is necessary to cover shifts. This means that other workers are required to work substantial amounts of overtime to cover the vacant positions.

Also, there is a vicious cycle between overtime and fatigue. As overtime increases, the fatigue levels rise among workers and the likelihood of a fatigue-related accident increases dramatically.

6. Accidents

Compared to day workers, night workers make five times more serious mistakes and are 20% more likely to suffer a severe work-related accident.⁶

The Flawed Mentality

Similar to the flawed mentality that the Titanic was an unsinkable ship, many managers consider their successful operations to be unstoppable as well. However, history tells a different story.

History tells the unfortunate tale of the many operations that chose to ignore worker fatigue and suffered loss of life, sky-high costs and catastrophic destruction – as was the case in infamous 1986 Chernobyl disaster, where control room operators working long hours at night to meet a deadline made disastrous decisions.

Image from boston.com

Fatigue-related error was deemed a contributing factor to the 1986 Chernobyl Disaster.

Solution: Fatigue Risk Management Systems

A fatigue risk management system (FRMS) is a data-driven, risk-informed, safety performance-based program that reduces the risk of fatigue-related incidents in 24/7 operations. An FRMS continually monitors and reduces the risk for fatigue-related accidents.

Fatigue risk management systems (FRMS) fit within an organization’s overall health and safety program and are now the globally-accepted standard for managing the risk of employee fatigue in safety-sensitive businesses.

Download Our Free White Paper!

To learn more about fatigue and its impact on 24/7 operations, download our FREE white paper:

The Myths & Realities of Fatigue

Reducing the Costs, Risks, and Liabilities of Fatigue in 24-Hour Operations

CIRCADIAN® FRMS and 24/7 Workforce Solutions

 CIRCADIAN® is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock.  Through a unique combination of consulting expertise, research and technology, software tools and informative publications, CIRCADIAN helps organizations in the 24-hour economy optimize employee performance and reduce the inherent risks and costs of their extended hours operations.


REFERENCES

1. CIRCADIAN (2007). Shiftwork Practices 2007.
2. Ricci, J. A., Chee, E., Lorandeau, A. L., & Berger, J. (2007). Fatigue in the US workforce: prevalence and implications for lost productive work time. Journal of Occupational and Environmental Medicine, 49(1), 1-10.
3. CIRCADIAN (2014). Shiftwork Practices 2014.
4. Durmer, J. S., & Dinges, D. F. (2005, March). Neurocognitive consequences of sleep deprivation. In Seminars in neurology (Vol. 25, No. 1, pp. 117-129).
5. Owens, J. A. (2005). The ADHD and sleep conundrum: a review. Journal of Developmental & Behavioral Pediatrics, 26(4), 312-322.
6. Moore-Ede, M. C. (1993). The twenty-four-hour society: understanding human limits in a world that never stops. Reading, MA: Addison-Wesley.

 

^ 

 

Would You Hire This Night Shift Manager?

So, would you hire this applicant?

No way! You would NEVER hire this applicant – he’s a nightmare for a company!

So WHY do you let your current workers transform into this worker?

The attributes listed above are just a few of the negative effects of cognitive fatigue and sleep deprivation.

Benchmarking Fatigue Issues

According to CIRCADIAN's 2014 Shift Work Practices survey data, one-third (33%) of workforce managers believe that fatigue is a moderate or severe problem among their workers. To no surprise, these workforces experience significant problems with absenteeism, turnover and excessive overtime.

Figure 1: Worker Fatigue Levels & FRMS Implementation¹

Do you have a fatigue risk management system?

Unfortunately, only 10% of workforces have a fully implemented, comprehensive FRMS in place.

Workforces that have implemented fatigue risk management programs experience fewer problems with absenteeism, turnover and excessive overtime. Employees in these workforces have greater morale, less stress, and are more productive workers.

What is a fatigue risk management system?

New laws, regulations and ANSI standards are continually published that require more companies and industries to design and implement an FRMS.

Is fatigue impacting your workers?

It can be challenging to determine if fatigue is negatively impacting your workforce. Some tell-tale signs of worker fatigue issues can include:

• Increase in absenteeism rates (especially unexpected absenteeism)
• Increased rates of errors and accidents
• Lowered productivity
• Sluggish employees
• Increased caffeine consumption among workers

Best Fatigue Management Practices

To learn more about best practices of fatigue management and it's role in 24/7 operations, we suggest reading the following informative white papers:

 

Also, make sure to check out our ‘Evolution of Fatigue Risk Management’ white paper & infographic which detail how fatigue risk management was conceived, the evolution of FRMS, its scientific basis, and the reasons it has remained under the radar for more than 20 years.

	                          Â

CIRCADIAN^® FRMS and 24/7 Workforce Solutions

CIRCADIAN is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock.  Through a unique combination of consulting expertise, research, software tools and informative publications, CIRCADIAN helps organizations in 24/7 workforces optimize employee performance and reduce the inherent risks and costs of their extended hours operations.


1. CIRCADIAN Shift Work Practices, 2014

Are costly, unexplainable accidents occurring at your company? Fatigued workers may be the culprit.

Not convinced? Just ask Tom Voelkel, the CEO of Dupre’ Logistics, who sought the professional help of CIRCADIAN® after a series of unexplainable accidents threatened to bankrupt the trucking logistics company.

“We were having some serious accidents and we were having problems with rollover accidents. We were doing everything that we knew, but we didn’t realize that fatigue was the problem.” – Tom Voelkel, CEO, Dupre’ Logistics

CIRCADIAN helped Dupre’ Logistics with implementing a variety of fatigue risk management solutions, such as employee education and biocompatible shift scheduling, to address worker fatigue issues and reduce accident rates.

“We could not do this fast enough, this was knowledge we didn’t have. We were in a situation where our people were tired, and [CIRCADIAN®] had the medicine.” -- Tom Voelkel

Did CIRCADIAN® fatigue risk management solutions work?

Watch the full story below to find out.

Don’t have enough time to watch the video? Scroll down to see if CIRCADIAN was able to help save Dupre’ from the loss of insurance coverage.

(SPOILER ALERT)

Nine months after implementing CIRCADIAN fatigue risk management solutions, Dupre’ Logistics had the following results:

• 89% reduction in fatigue-related accidents
• Over $1 million saved in accident-related costs
• 50% reduction in driver turnover and absenteeism

“Looking back at it, [consulting with CIRCADIAN] was one of the best decisions that we’ve ever made in our company.”
- Tom Voelkel, CEO, Dupre' Logistics 

How can CIRCADIAN can help your company with fatigue risk management?

CIRCADIAN® is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock.  Through a unique combination of consulting expertise, research and technology, software tools and informative publications, CIRCADIAN helps organizations with traditional and/or extended operating hours optimize employee performance and reduce the inherent risks and costs of sleep deprivation and fatigue.

CIRCADIAN 24/7 workforce solutions include:

• staffing level analysis
• shift scheduling
• employee education & training
• fatigue risk management software

Download one of our many informative white papers that highlight strategies for reducing fatigue-related accidents and costs.

For many people, the 24/7 nature of our society has caused people to believe that chronic fatigue is an acceptable way of life. This has led many people to disregard their sleep issues (e.g. waking up in the middle of the night, difficulty falling asleep). However, what is often believed to be a simple sleep issue is actually a diagnosable sleep disorder.

A significant but commonly overlooked concern in 24/7 workforce health and safety is the high prevalence of “Obstructive Sleep Apnea Syndrome” (OSA), which is one of the roughly 70 sleep disorders listed in the International Classification of Sleep Disorders Diagnostic & Coding Manual. Obstructive Sleep Apnea can become a serious health issue if left untreated. Symptoms of OSA can include disturbed sleep and excessive sleepiness during the day (National Sleep Foundation, 2014).

The ripple effect of OSA can dramatically impact not only the sufferer, but also their spouse, friends, family, and even their employer. Most managers recognize that understanding and addressing the issues of a 24/7 lifestyle can dramatically improve the bottom line of the company; yet, health issues like OSA continue to be overlooked as contributing to excess costs.

How much do employees with sleep apnea cost their employers? CIRCADIAN conservatively estimates that each undiagnosed employee in the workforce costs an additional $6,000 per year in OSA-related expenses.

What is OSA?

Obstructive Sleep Apnea (OSA) is a disorder of the respiratory system manifested by repeated cessations of breathing during sleep that can cause arousal from sleep multiple times per hour. In OSA, the upper airways collapse during sleep so as to prevent the movement of air into the lungs. Obstructive Sleep Apnea typically develops with increasing severity over a period of several years.

The period of cessation of breathing called “apneas” prevent the oxygenation of the blood in the pulmonary capillaries and, as a result, the arterial blood oxygen levels rapidly fall. Carotid body oxygen sensors detect the drop in oxygen levels, causing an abrupt arousal from sleep and gasping for air before the sufferer falls back into sleep again. Because this pattern can repeat many times per hour, the result of sleep apnea is reduced sleep quality and quantity, leading to chronic sleep deprivation. The effects of sleep deprivation and the repeated episodes of blood deoxygenation affect the neurological and cardiovascular systems.

Animation of Obstructive Sleep Apnea

Risk Factors & Prevalence

Several studies have described the average prevalence of OSA in different populations as ranging from 2% to 33% (Young, 1993; Agency for Healthcare, Research and Quality, 2000).

The sleep specialist community conservatively estimates that 5% of the U.S. working-age population suffers from OSA. However, a steady increase in the proportion of obese people in the U.S. population may directly increase the prevalence of OSA going forward.

CIRCADIAN’s databases (containing data from more than 10,000 shift workers) show that 11% of shift workers have OSA and 15% display key symptoms of OSA or other sleep disorders related to excessive sleepiness. Given the increased prevalence of OSA risk factors among shift workers, it is not surprising that OSA is more common in shift work populations as compared to other populations.

Recognized risk factors for OSA include:

• Smoking (Kashyap, 2001)
• Obesity
• Having a neck size of 17” or greater
• Regular use of alcohol or sleeping pills
• Moderate sleep deprivation (National Institute of Health, 2003)

Health Implications

Due to interrupted sleep patterns, many individuals with OSA infrequently have restorative sleep episodes, which can potentially manifest into excessive daytime sleepiness, increased accidents, and more frequent health problems, such as:

• 40% increased rate of excessive daytime sleepiness (Ulfberg, 1996)
• 2 times as many traffic accidents per mile (Horstmann, 2000)
• 3 times greater risk of occupational accidents (Ulfberg, 2000)
• 1.3 to 2.5 times more hypertension (Krieger, 2002; Smith, 2002)
• 2.2 times increased risk of nocturnal cardiac arrhythmia (Smith, 2002)
• 3.9 times more likely to have congestive heart failure (Smith, 2002)
• 1.6 times increased chance of stroke (Mooe, 2001; Shahar, 2001)
• 1.4 to 2.3 times greater risk of heart attack (Saito, 1991; Shahar, 2001)
• 40% increased risk of depression (Smith, 2002)

In one study consisting of 421 patients being evaluated for possible sleep apnea, researchers found that up to 95% of people who were positively diagnosed with OSA thought that they just had a snoring or fatigue problem, causing sleep specialists to suggest that high-risk groups should be educated and screened (Baumel, 1997).

Costs

Given the myriad of health problems associated with OSA, it is no surprise that employees with untreated OSA cost employers significantly more each year than employees with treated sleep apnea or no apnea.

According to CIRCADIAN’s calculations, a highly conservative estimate of the yearly excess cost per employee with unmanaged OSA is approximately $6,091. This means that in a shiftwork population where 11.6% of the workers are unmanaged OSA sufferers, these costs would equate to $706,556 per one thousand workers every year ($6,091 x 116 workers).

These apnea-related excess costs are often accrued from increased physician and hospital visits, cardiovascular treatment costs, increased on the-job injuries, and absenteeism, to name a few. Table 1 details the discrepancies between employees with treated vs untreated sleep apnea in terms of the average yearly excess costs per employee.

Table 1. Yearly Excess Costs per Employee: Treated vs Untreated Sleep Apnea

Treatment

In order to mitigate the risks associated directly with OSA, and lower the sufferer’s risk to the same level as a non-OSA worker, the obstruction of the airway during sleep must be prevented. In short, the individual with OSA needs to keep breathing.

General measures are often effective. These include weight loss, avoidance of alcohol and sleeping pills, use of medication to relieve nasal congestion, and use of oral appliances that modify the position of the tongue, soft palate or jaw. More extreme measures include nasopharangeal surgery, although the long term efficacy of this approach is questionable due to the accumulation of scar tissue. However, the medically recognized method for maintaining an open airway in those suffering from moderate to severe OSA is “Continuous Positive Airway Pressure,” or CPAP for short.

Most employees receiving CPAP treatment experience a dramatic improvement in their health and quality of life (Sin, 2002), and their health care costs return to normal levels. Performance (as measured by tests of simulated driving, daytime sleepiness, cognitive performance and mood) shows significant improvements (Weaver, 2001), while absenteeism diminishes after treatment (Servera, 1995). Adverse health and performance consequences and costs associated with OSA can be reversed in compliant, treated employees.

Managing Employee OSA

Though OSA can be a highly disruptive disorder in its unmanaged state, the costs of accidents and health problems are mitigated when OSA sufferers receive treatment to correct the airway obstruction during sleep. However, in order to receive a non-invasive, corrective treatment, the individual needs to know that he or she has OSA in the first place.

Company Sponsored Education Initiatives

There are several challenges to overcome in order to ensure a successful outcome for a company-sponsored OSA education initiative; however, the benefits of implementing a program can be substantial.

Managers report returns from reductions in healthcare, absenteeism, turnover, presenteeism, and overtime costs, as well as longer-term benefits in workers’ compensation payments, insurance premiums, and ultimately brand value.

Interested in learning more about employee education initiatives?

Visit CIRCADIAN.com to download a free white paper titled “Shiftwork Lifestyle Training: Employee and Employer Benefits”.

About CIRCADIAN

CIRCADIAN® is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock.  Through a unique combination of consulting expertise, research and technology, software tools and informative publications, CIRCADIAN helps organizations with traditional and/or extended operating hours optimize employee performance and reduce the inherent risks and costs of sleep deprivation and fatigue.