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American workers today are more stressed out than ever before -- a situation that U.S. businesses can't afford to ignore, says Hopkins' top "occupational doc," Edward Bernacki. For proof, he says, just look to the bottom line.

By Tom Nugent
Illustration by David Plunkert

One summer afternoon back in 1961, a college kid named Ed Bernacki was hard at work in a Connecticut ball bearing factory. His job: operating a large, noisy machine that sliced steel bars into "chunks of metal about the size and shape of Tootsie Rolls," he recalls.

As a hard-charging sophomore at nearby Fairfield University, the 19-year-old was already dreaming of a career in medicine. He was also quite grateful for this relatively high-paying factory job, which would help him meet tuition bills in the fall.

But the work was tedious and difficult. And noisy? Day after day that summer, the kid from New Britain stood beside his clattering steel-cutting machine, wincing at the ear-splitting racket that thundered all around him. And this particular afternoon in July would be no different. After several hours of cutting oil-soaked steel, Bernacki was relieved to step away from his machine to begin a 15-minute break. Hoping for a little conversation, he shouted at a fellow worker as the two of them strolled across the factory floor: "Say, it's pretty damn noisy in here, don't you think?"

Frowning, the co-worker cupped a hand around one ear. "What'd you say?"

"I said it's pretty NOISY in here!"

The other worker nodded and grinned. Then he hollered at the college boy: "Don't worry about all the noise. If you work at this plant a few more years, you won't even hear it!"

Remembering that incident today, the 60-year-old Bernacki shakes his head. "You know, it took me a few years to understand what that guy was really saying. Unfortunately, the reality was that he and many of the other workers in that factory were literally going deaf -- and they simply assumed that losing their hearing was the price they had to pay in order to hold down a steady job."

U.S. employees putting in more than 50 hours per week: 24% Ask Edward J. Bernacki why he became an "occupational doc," and the executive director of Health, Safety, and Environment at Johns Hopkins will tell you a dozen stories like that one.

"I think that incident at the Fafnir ball bearings plant taught me something important about preventive medicine," says Bernacki, who earlier this year was elected president of the 6,000-member American College of Occupational and Environmental Medicine (ACOEM). "The lessons I learned at that factory -- and later in medical school -- have stayed with me to this day."

During the decade he's been at Hopkins, Bernacki has transformed the Department of Occupational Medicine at the School of Medicine into a growing entrepreneurial enterprise that has become a working model for hospitals across the nation, which are lining up for counsel and advice. The department currently contracts with more than 500 companies in the mid-Atlantic region, covering nearly 300,000 employees -- and generates more than $2 million a year in revenues. Hopkins doctors, nurses, and safety professionals go to sites across the region to assess workplace environments and consult with clients about potential hazards. For many of the workers, Hopkins is the primary care provider for treating work-related ailments such as toxic exposures, back pain, and repetitive trauma disorders.

In recent months, the department has embarked on several other initiatives, such as monitoring the health of workers for a Nevada-based company engaged in disposing of chemicals and other hazardous wastes for the federal government.

U.S. employees who work 6 and sometimes 7 days per week: 22% Closer to home, where Bernacki is responsible for managing the health and safety programs that protect Hopkins' 39,000 employees, he and his staff have managed to cut workers' compensation costs at Hopkins by more than $4 million annually, through innovative programs in ergonomics-based injury prevention and better management of patient care.

A widely published authority on occupational health issues, Bernacki says he's especially concerned about the "rapidly increasing stress levels that are now transforming the American workplace." He has been warning both the U.S. Congress and the public for some time that the nation's 134 million workers are being stressed by demands for increased productivity as never before.

"I think we're at a crossroads right now in the American work force," says Bernacki. "There's no doubt that economic 'globalization' has been putting increased demands -- and increased stress -- on American workers in recent years. At the same time, both partners in the typical family setting are working full-time jobs now, which only adds to the time pressure. You don't have to be a specialist in occupational medicine to see the effects of this stress on many of the employees we treat and out there in the work force at large."

The challenge, says Bernacki: to build and manage systems to reduce workplace stress, while teaching workers to better cope. According to the latest worker survey conducted by the National Institute for Occupational Safety and Health (NIOSH), more than 29 percent of American workers now describe their jobs as "extremely stressful" day in and day out. Another recent national survey -- this one by the U.S. Families and Work Institute -- showed that 25 percent of all U.S. employees have "felt like screaming and shouting at times on the job," and 14 percent "felt like striking a co-worker" because of work-related stress.

"The workload for many employees has expanded greatly," partially due to such rapidly evolving work tools as the Internet, the fax machine, and the cell phone, Bernacki notes. These days, the markets never close, e-mail never stops arriving, and you're never really "away" from the office as long as your cell phone is turned on. At the same time, many workers are experiencing an erosion of their sense of autonomy. Employees who are forced to give up their lunch hours or stay late without overtime compensation, says Bernacki, begin to perceive themselves as workplace "victims" rather than as freely motivated individuals who enjoy making a contribution each day.

Beyond the daily emotional burden such stress puts on workers, there's the costly long-term risk to health: ulcers, hypertension, migraine headaches, heart ailments, and clinical depression.

The latest numbers from the U.S. Department of Labor appear to confirm what Bernacki and other workplace observers have long suspected: Americans are now working more hours, on average, than employees in any other industrialized nation. According to the Labor Department data, U.S. workers now rack up an average of 1,942 hours on the job each year -- an increase of 36 hours, or nearly an entire work week -- since 1990. The same data show that workers in England and Brazil are working fully 250 hours (or five weeks) less than Americans do each year. The super-efficient Germans put in a startling 500 fewer hours (12.5 weeks) per year than their American counterparts.

"The data prove that it's gotten much tougher to be an American worker in recent years," says Bernacki. "Right now, one of our biggest challenges in occupational medicine is to build and manage systems that will reduce workplace stress as much as possible -- while also teaching workers how to cope better with it."

Preventing injury in the workplace "isn't rocket science," says Bernacki. His Rx: figure out what led to an injury, to discover patterns and similarities.
Photo by Keith Weller
When Bernacki signed on at Hopkins in 1991 as executive director of Health, Safety, and Environment, he faced a formidable challenge. The number of "days paid" for injured Hopkins employees who couldn't make it to work because they'd been hurt in the workplace averaged approximately 35,000 per year -- at a cost of 81 cents per $100 of payroll. Hopkins was paying more than $5 million in costs per year for a work force that at that time totaled 21,000 employees. (The most significant injuries were related to the back; needle-stick injuries also posed a major problem.)

Bernacki set to work with a formula for enhanced occupational wellness that, he says, is actually quite simple. "I call it 'rationalization of the workplace.' Really, this isn't rocket science. Before coming to Hopkins, I spent 11 years as the vice president of health, safety, and environment for Tenneco Inc. in Houston, and prior to that, I was the medical director for United Technologies in Hartford, Connecticut. Both were 'Fortune 20' companies.

"Those two jobs really taught me the importance of common sense -- using your head -- in order to figure out the best way to prevent accidents and take care of people who do get hurt."

The key to reducing injuries, Bernacki says, is to immediately evaluate the conditions that led to the injury, in order to discover patterns and similarities. When somebody at Hopkins sustains a serious injury, Safety and Environmental Health officers immediately launch an accident investigation. In many instances, the condition that triggered the accident can be quickly improved to prevent further accidents. Notes Bernacki: "We don't just 'take down the details' -- we study them carefully for clues. We analyze all of the factors involved. For example: We had several bad falls in one particular area of the hospital a few years ago. So we studied them. Do you know what we found? One of the culprits was the floor wax! The wax we were using had a low 'coefficient of friction,' which means that it's more slippery, making it more prone to cause a tumble. We switched to a wax with a much higher coefficient of friction and we've had fewer accidents as a result."

U.S. employees who never use their vacation time: 25% Bernacki also describes himself as a "fanatic" when it comes to repetitive stress disorders. In 1992, he initiated a program that encouraged Hopkins employees to report even the slightest wrist pain and to perform on-the-job "ergonomic surveys." Work areas that were shown to have ergonomic stressors could often be corrected with simple solutions -- such as adjusting chair heights or providing wrist rests for computer users. Unfortunately, the initial survey revealed that a number of employees were suffering from carpal tunnel syndrome -- severe enough to require surgery. The good news: In the years since Bernacki's ergonomic program was put in place, additional cases of "irreversible" carpal tunnel syndrome have been rare.

Bernacki applied the same "rationalization" philosophy to his quest for environmental safety at Hopkins by installing dozens of state-of-the-art "controlled entry" labs, virtually eliminating danger from toxic fumes. "I never wait for environmental problems to crop up," he says. "I attack them in advance. Everywhere I go in my travels around Hopkins, I'm asking: 'Do you have a funny smell? Any fumes?' If it's happening in your lab, we want to know about it!"

In his role as consultant, Bernacki counsels businesses to resist the temptation to treat on-the-job injuries simply as a cost of doing business. Instead, he says, he urges managers to "think of injury-reduction as an opportunity to increase productivity."

"You gotta be proactive!" he says with evangelical fervor, noting that his department conducts one-on-one training for individuals on such subjects as the safe use of laboratory animals and hazardous materials, as well as fire safety and evacuation of buildings.

U.S. employees who find their jobs "very" or "extremely" stressful: 40% "The tragic events of September 11 taught us the vital importance of knowing how to evacuate buildings effectively," he says. "At the World Trade Center, that know-how apparently saved more than 60,000 lives. We have since initiated a similar program here at Hopkins, designed to protect our employees in the event of a mass disaster."

When a Hopkins employee does get hurt or sick, the individual is first assessed in one of the clinics staffed by physicians and nurses from Occupational Medicine. Cases too complex to be treated there -- such as fractures and severe lacerations -- are referred to other Hopkins physicians in a variety of specialties. Employees are always free to ask for a reassessment, or to go elsewhere for their care. "Without the trust of the employee, the whole system fails," Bernacki says.

How effective have these programs been at reducing injuries? Hopkins injury claims reviewed by two outside auditors show that under Bernacki's leadership, the number of "days paid" for injured Hopkins employees who couldn't make it to work because they'd been hurt in the workplace declined -- from 5.5 per $100,000 of payroll in 1991 to 1.1 in 2002. At the same time, the number of lost-time claims dropped from 22 per 1,000 employees to 5 per 1,000 employees in 2002. "The drop in the number of lost-time claims is related to improving working conditions and our ability to get medical conditions treated promptly -- and not to increased claims denials. In fact, as the number of claims decreased, the number of cases brought to the Workers' Compensation Commission for appeal dropped dramatically," he says.

That improvement in the Hopkins safety rate meant that "losses per $100 of payroll" also plummeted -- from 81 cents per $100 in FY 92 to only 37 cents in FY 02. The bottom line, according to Bernacki: "Our auditors tell us that our program has saved Johns Hopkins at least $35 million since '91."

Carl Gattuso, the senior vice president for finance at Virginia Commonwealth University in Richmond, Virginia, says he's become a "huge fan" of the Bernacki approach to workers' compensation management. "We spent several years studying our occupational medicine program at VCU," says Gattuso, "and then we asked Dr. Bernacki and his people to come in and review all of our systems. In the end, we were so impressed that last year we turned our entire workmen's compensation injury program over to his unit at Johns Hopkins.

"We were especially pleased with Bernacki's emphasis on prevention. He insists that when someone falls and breaks a hip, we go right to the scene and make sure we understand exactly why the accident happened. He's been so effective at preventing these kinds of accidents that we basically asked Johns Hopkins to run all of our case-management and safety programs."

While Bernacki labors tirelessly to boost occupational medicine at Hopkins and elsewhere on his consulting rounds, the man who runs several miles a night and habitually skips lunch frets daily over the "obvious increase in psychological stress" that now affects virtually everyone in the American workplace.

"I don't think there's any question but that the information-transfer jobs are a hell of a lot more stressful now. And realistically, we can't do too much about that. But what we can do is help employees deal more effectively with their lives away from the job -- so that they can focus better and feel less pressure when they do come into work each day."

Operating under the aegis of the Hopkins Faculty and Staff Assistance Program, Hopkins' stress-reduction strategy includes free services, such as on-site counseling and "work-life" programs, that seek to help employees reduce stress and thus improve performance. At Hopkins, as with many other large employers today, employees can find help and information on issues ranging from child care to retirement planning. Lunchtime support groups are available for staffers going through painful divorces, for those juggling the needs of a parent with Alzheimer's, or those coping with the loss of a child or partner.

"It's very interesting to see how the workplace has changed," Bernacki notes. "Ten or 15 years ago, most Hopkins workers who took advantage of our on-site counseling were struggling with substance-abuse problems. But that's not true anymore.

U.S. employees who report working in a "violent atmosphere" caused by stress: 10% "These days, you're likely to find that an employee has come to counseling with complaints about being 'overwhelmed by stress.' They tell us things like: 'There's so much work to do that it's difficult to get through the day.' The good news is that employees are able to tell us things that they wouldn't dare discuss with a supervisor. And this is where we can really step in and help -- by working to organize the employee's time better, for example, or by exploring ways that he or she can communicate better with a difficult supervisor."

As the recently installed president of ACOEM, Bernacki says he's eager to "beat the drums" on the importance of injury prevention and stress reduction in the American workplace. He's also determined, he says, to continue spreading his gospel message -- the crucially important fact, given today's highly competitive global marketplace, that preventing accidents and lessening stress aren't just a matter of social responsibility. "Managers need to understand," he insists, "that taking good care of workers makes good business sense.

"These days, the costs to U.S. businesses of injury and ill health among workers account for up to 10 percent of the final cost of most products," says Bernacki. "Whenever I make a speech for ACOEM or talk to a company in the region, I hammer on that theme. I tell them: If we can reduce the medical costs of injury in the workplace by even 4 or 5 percent, that's huge! From an employer's perspective, the economic effect of ill health involves the direct cost of diagnosis and treatment, disability costs, higher wage cost, lost production, employee turnover, planned overstaffing, and indirect business taxes.

"These days, the direct and indirect costs to U.S. businesses of injury and ill health among workers account for up to 10 percent of the final cost of most products. Reduce those costs and you gain a significant pricing advantage for American industry. I've been making this speech for several years now, but a lot of managers haven't figured it out yet."

Make no mistake, says Ed Bernacki: American business and institutional managers will soon be required to "get control over the problem of stress and preventable illness in the workplace, or they are going to watch their efficiency go right down the drain." Yet he remains upbeat about the nation's ability to figure out ways to solve these problems.

"Occupational medicine can become a significant force in ensuring that U.S. business is as productive as possible. All we need is the creativity -- and the will -- to get it done."

Tom Nugent is a freelance writer who lives and works in Michigan.

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