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9


Work Now and in the Future

Much has been written about the nature of work and how it is influenced by ever advancing technology, shifts in market forces, the demographics of the workforce, and changing occupational structures (National Research Council, 1999a; Howard, 1995). The central theme both now and in the future is diversity in workers, jobs, workplace design, and work location. At the level of industries and occupations, changes have been occurring for a number of years. For example, there has been a shift from blue-collar work to service work, a trend toward teamwork, and an increasing need for all levels of employees to develop new skills for working with technology. Current trends also indicate continuing part-time employment, outsourcing, mobility of workers among jobs both within and between occupations, and an aging workforce with an increasing number of women and minorities. Furthermore, it has been suggested that the current trend in work outside the traditional work setting will continue to expand.

The scholarly treatment of workplace trends has focused almost exclusively on organizational issues and personnel policies rather than on changes in the content of specific jobs and occupations. In this chapter, we attempt to piece together a description of the current and projected content of work and the implications for the occurrence of musculoskeletal disorders. We begin the discussion with an overview of the growth and decline of occupations in the past and the projected trends for the future. This discussion focuses on the types of jobs that have produced the highest percentage of musculoskeletal disorders injury reports in the last decade—those associated with materials handling—and the expected changes anticipated in these jobs in the next decade. The second part of the chapter examines the external variables that influence changes in



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Page 330 9 Work Now and in the Future Much has been written about the nature of work and how it is influenced by ever advancing technology, shifts in market forces, the demographics of the workforce, and changing occupational structures (National Research Council, 1999a; Howard, 1995). The central theme both now and in the future is diversity in workers, jobs, workplace design, and work location. At the level of industries and occupations, changes have been occurring for a number of years. For example, there has been a shift from blue-collar work to service work, a trend toward teamwork, and an increasing need for all levels of employees to develop new skills for working with technology. Current trends also indicate continuing part-time employment, outsourcing, mobility of workers among jobs both within and between occupations, and an aging workforce with an increasing number of women and minorities. Furthermore, it has been suggested that the current trend in work outside the traditional work setting will continue to expand. The scholarly treatment of workplace trends has focused almost exclusively on organizational issues and personnel policies rather than on changes in the content of specific jobs and occupations. In this chapter, we attempt to piece together a description of the current and projected content of work and the implications for the occurrence of musculoskeletal disorders. We begin the discussion with an overview of the growth and decline of occupations in the past and the projected trends for the future. This discussion focuses on the types of jobs that have produced the highest percentage of musculoskeletal disorders injury reports in the last decade—those associated with materials handling—and the expected changes anticipated in these jobs in the next decade. The second part of the chapter examines the external variables that influence changes in

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Page 331work, including: (1) workforce demographics, (2) technology, (3) the globalization of markets, and (4) organizational structures, policies, and procedures. The final section presents a summary of the implications of anticipated trends in work on the occurrence of musculoskeletal disorders. TRENDS IN EMPLOYMENT BY INDUSTRY SECTOR AND OCCUPATION Distribution of Workers According to Franklin in the Monthly Labor Review (1997), the service-producing industries such as finance, government, health, transportation, communications, wholesale and retail trade, and utilities are the fastest-growing sector in the economy (see Table 9.1). In 1986, these industries represented 66 percent of all jobs; in 1996 they represented 71.2 percent; and by 2006, they are projected to reach 74 percent (almost 112 million jobs). In contrast, goods-producing industries such as mining, construction, and manufacturing declined from 22 percent (23.5 million jobs) in 1986 to 18.5 percent in 1996 and are projected to decline further to 16.2 percent by 2006 (23.4 million jobs). Although this sector is declining in relative terms, the absolute number of people employed is relatively constant due to an increase in total workforce size over the time frame. For our purposes, it is important to note that there are many physical jobs in the service industry (e.g., nursing, parcel delivery, maintenance) and many jobs with no physical demands beyond those traditionally associated with office work in the goods-producing industries (managers, accountants, etc.). We can relate the sector of employment directly to the task demands through data collected between 1979 and 1993 and analyzed by sector. Landau et al. (1996) used a database of 3,893 jobs from the Arbeitswissenschaftliche Erhebungsverfahren zur Tätikgkeitsanalyse (AET) job analysis system that quantifies many aspects of task demands. Classifying jobs by sector using the Standard Industrial Classification (SIC) code shows which sectors were over- and underrepresented on each dimension of the task. Table 9.2 shows the job sectors that were overrepresented for each type of stressor. Further analysis of these data by gender shows that more men are engaged in heavy dynamic work; in the light active work category, men tended to work with heavier loads. Women's work focuses on more repetitive tasks. With regard to information processing work, men are more likely to hold jobs with high knowledge requirements and qualifications. Table 9.3 (taken from Silvestri, 1997) shows the percentage of employment by major occupational group for 1986, 1996, and projected for 2006.

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Page 332 TABLE 9.1 Employment by Major Industry Division, 1986, 1996, and Projected 2006 (after Franklin, 1997) Thousands of Jobs Percent Distribution Industry 1986 1996 2006 1986 1996 2006 Totala 111,374 132,352 150,927 100.0 100.0 100.0 Nonfarm wage and salarya 98,727 118,731 136,318 88.6 89.7 90.3 Goods producing 24,538 24,431 24,451 22.0 18.5 16.2 Mining 778 574 443 .7 .4 .3 Construction 4,810 5,400 5,900 3.3 3.1 3.9 Manufacturing 18,951 18,457 18,108 17.0 13.9 12.0 Durable 11,200 10,766 10,514 10.1 8.1 7.0 Nondurable 7,751 7,691 7,593 7.0 5.8 5.0 Service producing 74,189 94,300 111,867 66.6 71.2 73.1 Transportation, commnications, utilities 5,247 6,260 7,111 3.7 3.7 3.7 Wholesale trade 5,751 6,483 7,228 5.2 3.9 3.8 Retail trade 17,878 21,625 23,875 16.1 16.3 15.8 Finance, insurance and real estate 6,275 6,899 7,651 5.6 5.2 5.1 Servicesb 22,346 33,586 44,852 20.1 25.4 29.7 Federal government 2,899 2,757 2,670 2.6 2.1 1.8 State and local government 13,794 16,690 18,480 12.4 12.6 12.2 Agriculturec 3,327 3,642 3,618 3.0 2.8 2.4 Private household wage and salary 1,235 928 775 1.1 .7 .5 Nonagricultural self-employed and unpaid family workersd 8,085 9,051 10,216 7.3 6.8 6.8 aEmployment data for wage and salary workers are from the BLS Current Employment Statistics (payroll) survey, which counts jobs, whereas self-employed, unpaid family worker, agricultural, and private household data are from the Current Population Survey (household survey), which counts workers. bExcludes SIC 074,5,8 (agricultural services) and 99 (nonclassifiable establishments), and is therefore not directly comparable with data published in Employment and Earnings. cExcludes government wage and salary workers, and includes private sector SIC 08.09 (forestry and fisheries). dExcludes SIC 08.09 (forestry and fisheries). It can be seen that white-collar executive, managerial, and professional jobs are increasing along with technical, marketing, and service work. However, a decline is expected in the number of more physical jobs associated with agriculture, precision production, and operator/fabricator/ laborer. Even so, Silvestri (1997) suggests that approximately 26 percent

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Page 333 TABLE 9.2 Sector Analysis of Work Factors (after Landau et al., 1996). Sectors of business were compared for each type of stressor, with significantly overrepresented sectors listed in the table. Type of Stressor Overrepresented Sectors Heavy dynamic work Building, agriculture, home Active light work Manufacturing, home Static work Transportation, communications Proprioceptive input Building, public sector Information load Service, public sector Mental stress Service, public sector Environmental stress Mining, manufacturing, building TABLE 9.3 Employment by Major Occupational Group, 1986, 1996, and Projected 2006 (after Silvestri, 1997) Numbers in Thousands of Jobs Employment Number Percent Distribution Occupational Group 1986 1996 2006 1986 1996 2006 Total, all occupations 111,375 132,353 150,927 100.0 100.0 100.0 Executive, administrative, and managerial 10,568 13,542 15,866 9.5 10.2 10.5 Professional specialty 13,589 18,173 22,998 12.2 13.7 15.2 Technicians and related support 3,724 4,618 5,558 3.3 3.5 3.7 Marketing and sales 11,496 14,633 16,897 10.3 11.1 11.2 Administrative support, including clerical 20,871 24,019 25,825 18.7 18.1 17.1 Service 17,427 21,294 25,174 15.6 16.1 16.7 Agriculture, forestry, fishing, and related occupations 3,661 3,785 3,823 3.3 2.9 2.5 Precision production, craft, and repair 13,832 14,446 15,448 12.4 10.9 10.2 Operators, fabricators, and laborers 16,206 17,843 19,365 13.6 13.5 12.8 of workers will fall into the latter three categories in 2007. Among the service occupations, food preparation and service (cooks, bakers, waiters, etc.) are expected to reach 6.3 percent of the workforce, while the health care occupations of nursing, nursing aids, and physical therapy are ex-

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Page 334 pected to reach 3.5 percent. In addition, the home health care field is expected to continue its growth, given the trends in medical insurance. Currently, more than 12 million people in the United States are involved in caregiving on either a full-time or part-time basis—some of these are medical professionals, and others are family members and friends. Many of the physical jobs associated with nursing in hospitals and nursing homes that have been linked to musculoskeletal disorders are also present in providing health care in the home. It is clear from these projections that the future of work will still include a large number of employees performing highly physical jobs involving manual materials handling tasks. This suggests that the workplace of the future will continue to contain risk factors for musculoskeletal disorders. Musculoskeletal Injuries and Illnesses Reported by Occupation The percentage of reported injuries or illnesses involving days away from work in 1997 that were attributed to repetitive motion or overexertion from lifting has been tabulated by Ruser (1999). Approximately 43.6 percent of the reports associated with overexertion from lifting and 49.7 percent associated with repetitive motion come from employees working in jobs in the operator/fabricator/laborer category. The next highest categories for lifting were service (18.3 percent) and technical/sales/administrative support (17.7 percent). For repetitive motion, the next highest categories were technical/sales/administrative support (21.6 percent) and precision/production/craft/repair (12.3 percent). It is interesting to note that overall the percentage of injuries or illnesses reported from lifting declined by 25 percent between 1992 and 1997; those attributed to repetitive motion declined by 16 percent. Since jobs in manual materials handling are a major source of reported musculoskeletal injuries and illnesses, we take the analysis another step and examine the types of workers' compensation claims resulting from work in jobs involving manual materials handling. This analysis is supplemented by data collected from a large number of companies on various features of manual materials handling tasks. Jobs involving such materials handling tasks as construction, meatpacking, parcel package delivery, transportation, and moving were the source of the greatest number of workers' compensation claims filed in the state of Washington between 1990 and 1997 for musculoskeletal disorders of the low back and upper extremities (Silverstein and Kalat, 1999). Another occupation with a significant number of claims was nursing home work that involved lifting and moving patients. According to an analysis performed at the Liberty Mutual Insurance Company

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Page 335 (Dempsey and Hashemi, 1999), 36 percent of these claims, over a 6-year period, were associated with manual materials handling jobs. Of these, approximately 70 percent were for problems with the low back and upper extremities. As for the nature of the injury (as classified by these authors), the highest category was strain (62 percent) followed by fracture (12.8 percent) and laceration (11.6 percent); sprains accounted for 6 percent. Ciriello and Snook (1999) conducted a study summarizing typical manual materials handling tasks performed at 2,442 locations across the country. They collected and analyzed data on lifting, lowering, pushing, pulling, and carrying activities covering a 13-year period. The results show that lifting tasks were acceptable for 81 percent of the men but for only 10 percent of the women; for lowering tasks, the percentages were 89 and 14; and for carrying tasks, they were 88 and 36 percent, respectively. Moreover, the median weights for the lifting and lowering tasks were significantly higher than the weight limits recommended by the National Institute for Occupational Safety and Health (NIOSH). The authors concluded that additional work was needed to reduce the risks in industry associated with manual lifting tasks. With the growing number of women in the workforce, these data are of particular interest. The data from Ciriello and Snook (1999) can also be analyzed for time trends to determine whether jobs have become easier or more difficult over the 12 years of data collection. The authors did not conduct a random survey of all jobs, but rather analyzed the jobs that had been submitted to them by insurance agents in their capacity as reducers of potential insurance claims. The authors claim that the jobs are representative of industrial practice, although they acknowledge that sample sizes have decreased over the time period covered. In fact, they probably represent more demanding jobs, as their median weights for lifting and lowering were about 20 kg, well above the 9.1 kg reported by Drury, Law, and Pawenski (1982) in a survey of about 2,000 box-handling jobs in industry. When analyzed for linear time trends, Ciriello and Snook's data show significant changes over 1981 to 1993, with jobs becoming less demanding over time. The changes were quite large in some cases; for example, there was a mean decrease in lifted weight of about 0.5 kg per year and an improvement in both lift distance and height (at the start of the lift) of over 10 mm per year. These trends, coupled with the continued promise of automation of heavy industrial tasks, suggest a decrease in workplace risk factors associated with manual lifting tasks. EXTERNAL FACTORS INFLUENCING THE NATURE OF WORK This section provides a general overview of factors that have influenced work in the past and are expected to have a continuing effect in the

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Page 336future. They include workforce demographics, technology, globalization of markets, and internal changes in organizational structures and practices as a result of the other three aspects. The implications of these factors on the nature of work and the occurrence of musculoskeletal disorders is also examined. Some factors may act to increase the risks for musculoskeletal disorders, whereas others may act to decrease the risks. Workforce Demographics One major source of change in the workplace is the worker. At the start of the 21st century, it is anticipated that there will be greater participation in the workforce by older workers, ethnic minorities, and women. Between 1990 and 2010, the general population is expected to increase by 25 percent, from 239.3 million to 301.1 million in 2010 (Sternberg and Coleman, 1993). The Bureau of Labor Statistics (1999b) has projected a 12 percent increase in the labor force by 2008. In this time frame, the age distribution in the labor force is projected to shift toward the older ages. The proportion of employees in the United States who are ages 55 to 64 is now growing at a faster pace than any other employee age group. By 2006, the median age of all workers will be 41 years, compared with 38 years in 1996. In 1998, there were over 16 million Americans age 55 or older still working; by 2006, workers 55 years and older will constitute 20 percent of the entire workforce. By 2010, the baby boom generation will start to reach age 65, and between now and then there will be a 16 percent growth in jobs but only a 4 percent growth in population. The baby boom cohort includes about 75 million people. As they start to retire in large numbers, severe labor shortages are predicted to begin as early as 2010 and continue for several decades after that. The problem is not only the shortfall of available employees but also the cost of replacing the more experienced workers with new workers who will require orientation and training. Employers will be looking for incentives to keep the older worker in the labor force. Job satisfaction will be a key consideration. There is also a trend in the general population and the workforce toward increased ethnic diversity. Sternberg and Coleman (1993) cite Bureau of the Census projections across all ethnic groups: These show a 1.4 percent increase in blacks between 1995 and 2020 (a change from 33.7 to 46.8 million) and a 6.6 percent increase in Hispanics for the same time period (a change from 26.5 to 53.3 million). The percentage of other races is also projected to increase between 1995 and 2020 from 4 to 6.5 percent (a change from 10.7 to 21.2 million). Over the longer term, such demographic changes will continue. For example, by 2050, only about half of the U.S. population (52.8 percent) is projected to be white, compared with almost three quarters (73.6 percent) in 1995 (Day, 1996). Overall, two-thirds of

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Page 337the expected increase in U.S. population by 2050 will have come from net immigration. Participation rates for women in nearly all age groups are projected to increase. Men's labor force participation rates are expected to remain constant in all five-year age groups; however, their overall rate is expected to decline as the population shifts to the older age groups with lower participation rates. In 1998, 46 percent of the labor force was female; by 2008, women will make up 48 percent of the labor force. A final demographic consideration is the increased presence of people with disabilities in the workforce. In 1999, the participation rate for persons with disabilities was only 29.7 percent compared with 81.9 percent for people without disabilities (Bureau of the Census, 1999). While projections of these data to future employment are not available, the Department of Labor expects people with disabilities to be one of the populations that will “experience particularly large increases” (U.S. Department of Labor, 1999:13). Some conditions, which may or may not represent legally defined disabilities, arise from illness and injury, such as musculoskeletal disorders. Note that all of these demographic considerations are for increased workforce participation. At current historical lows in overall unemployment, more of the population as a whole is now working and thus potentially exposed to musculoskeletal disorder risk factors. Also, because work in the home must still be performed, increase in work participation will increase a potential occupational exposure, augmenting nonoccupational exposure for more Americans. Another important consideration concerning the future workforce is the significantly increased duration of exposure to keyboards and computer terminals. Although adolescent injury patterns still reflect primarily back injuries, cuts or contusions, and burns (Brooks and Davis, 1996; Parker, 1993), computer use now begins in early childhood when nerve and muscle tissues are developing. Computer games, as well as educational uses, including taking notes in class using a laptop, are common practice among children and adolescents. Harris and Straker (2000) studied the use of laptops in schools and found that a large proportion of users experience discomfort with carrying and using laptop computers. One large study conducted at a major northeastern university found that a significant percentage of the student body is experiencing upper extremity pain associated with keyboard use (Katz et al., 2000). However, associations with well-defined clinical syndromes are not yet known. Technology A second major driver of change is technology. Technology not only shapes what people do but how they do it. New occupations are created,

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Page 338and others are eliminated. Skills and knowledge needed to perform some jobs are increased, while the requirements for other jobs are decreased. Although changes in technology leading to the reformatting of work have occurred with some regularity in most work settings, the rate of change has accelerated in recent years. Information technology is becoming a part of all jobs as computing power becomes less expensive and more distributed. In industrial and office settings, many information collection, processing, sharing, and dissemination tasks have been transferred to or augmented by computer systems and information networks. While only a few years ago the National Research Council was investigating the gap between investments in information technology and productivity improvement (National Research Council, 1994), it now appears that the gap has closed and that computing power is having a significant effect on both productivity growth and the nature of work. For example, current work design trends include just-in-time production and lean manufacturing (e.g., Womack and Jones, 1996). Both emphasize reduction of intermediate buffers in processes and the elimination of nonvalueadded work steps. The net effect is more tightly coupled production (and service) systems that have decreased error tolerance and place increased demands on the workforce. Today, there are many physical tasks previously performed by workers that are now being carried out by robots under the remote direction of human operators. A series of workshops organized by the National Institute for Working Life in Sweden as Work Life 2000 has reviewed many of the effects of technological change; for example, microfirms (Summary #20), the information society (Summary #19), information technology (Summary #22), and the welding industry (Summary #12). From the point of view of musculoskeletal disorders, the rise of technology not only increases the exposure of the workers to computer interfaces (including keyboards and screens), but also it creates more variability in work tasks and more psychosocial demands for quick turnaround performance. Furthermore, work stress may be increased by the fact that computers can monitor the performance of many tasks, thus providing management with keystroke-level information on productivity and errors. In Industry In industrial settings, technology has made possible the pursuit of customized product development and just-in-time manufacturing (Wall and Jackson, 1995). As a result, workers are taking on more responsibility for decision making and coordination; they are performing production tasks based on customer demands rather than on a mass production basis.

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Page 339Under the just-in-time manufacturing scenario, there is pressure for flexibility and responsiveness, products are only manufactured to order, inventories and work in progress are minimized, and workers have to move from one type of task to another in order to respond to the need. In this scenario, workers are assigned several tasks, reducing the opportunity for them to be engaged in repetitive motion for extended periods of time on one task. Workers may also have to work unexpected overtime to provide the rapid response inherent in a just-in-time production system. Again, there is a potential for longer hours of exposure to any workplace risk factors. At the end of 1998, Modern Materials Handling produced a special report outlining the major trends in materials handling technology. One major development is advances in software for warehouse management systems and the development of partnerships between these systems and transportation management systems. These partnerships are a reflection of changes in manufacturing processes (customization, just-in-time production) and the resulting changes in the supply chain. Other developments of note include advances in automating the sorting, storing, and delivery of materials, ranging in size and weight from truck bodies and motor assemblies to small parcels. Modern conveyors are now being equipped with sophisticated sorting and routing systems. Automated storage and retrieval systems are operated from remote workstations. Lift trucks are employed to move pallets from one location to another—an example of the increasing mechanization of materials handling. It is anticipated that these types of advances and others will be encouraged as long as managers believe that improved speed and efficiency in production will more than compensate for the cost of such equipment and that the number of lost hours from disabilities experienced by production line employees will decline. A prime example of materials handling jobs in the future is the type of work performed in the growing number of distribution centers. To meet the immediate demands of either a final customer or a retail store, the need has shifted to rapid packaging of a variety of components collected from many suppliers. For example, apparel manufacturers have computer systems that store inventory data to pull orders from the distribution center and, ultimately, from the manufacturers. Similarly, Internet booksellers must assemble customer orders from a variety of publishers and rapidly dispatch them. Distribution centers are characterized by minimal inventory and minimal response time to customer needs. Because of the variety required by customers, distribution centers often feature high-density storage, with storage locations 10 meters above ground level and minimal aisle width for stocking and order picking. Stocking is usually by the pallet-load,

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Page 340while order pickers must manually select from each pallet cases of those items required by each individual customer with customization. This typically requires manual handling in the restricted spaces defined by the pallet and the order-picking vehicle. Much of this work must be carried out at high levels above the ground, further restricting the operator with safety harnesses and more prescribed working methods. There is also a shift from picking entire cases of goods to picking individual pieces to assemble a customized order. Often, this form of order picking is performed along banked storage racks, filled by automated replenishment systems, onto a central conveyor. Characteristics of such work are the computer-optimized picking schedule (which leaves little room for individual operator skill) and strict production control, often using a financial incentive system to motivate operators to work faster. Under such conditions, the physical handling of items becomes more varied; more manual handling is lateral transfer rather than lifting/lowering. However, the pervasive time stress and the social isolation in these jobs may result in negative psychosocial pressures that can adversely affect worker productivity and job satisfaction. Although there are many shifts away from heavy lifting jobs, there are jobs such as picking and placing that could increase the risk factors for upper-extremity musculoskeletal disorders. Thus work in the future may pose a lower risk for back problems and a higher risk for upper extremity musculoskeletal disorders. In the Office In today's office, professional and technical employees, as well as administrative employees, find a large portion of their work is accomplished at a computer keyboard. The technologies that are having the greatest impact on supporting and encouraging this trend include (1) software advances for word processing, spreadsheets, and graphics packages and (2) network services such as electronic mail, distributed collaboration, and the availability of information on the Internet. The keyboard and the mouse, as key interface devices to the computer for information gathering, distributed collaboration, and information provision, have led to a wide debate concerning their role in the development of hand, wrist, arm, and shoulder repetitive stress injuries (e.g., carpal tunnel syndrome, wrist tendinitis, epicondylitis, tension neck syndrome). It is also important to note that screen placement and static loading from poor overall body posture can increase exposure to musculoskeletal disorder risk. According to Coovert (1995), in the future interfaces with the computer will involve touch screens and voice input. Weiser (1991, 1993) has proposed an intriguing view of the future in which computers will be

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Page 341everywhere but will be invisible. He suggests that three different types of systems will be available in the office of the future: post-it-sized computers called tabs, notepad-sized computers called pads, and wall-sized interactive surfaces called liveboards. Tabs function as an extension of the computer screen—information in a window can be compressed on a tab. A tab can serve as a storage device for a project or it can function as personal identifier for an individual. It would be equipped with a touch-sensitive screen and a series of buttons. A pad would be used like a piece of paper, and each office would have several of these. The liveboard, which would function like a white board, would support collaborative work and inputs could come from several sources, including pens, scanners, and gestures. If the interface devices of the future do move away from keyboard and mouse input, many of the physical symptoms currently attributed to computer use will be alleviated. However, the impact of touch screens, voice input, barcode readers, card swipes, and so forth, has yet to be determined. Moreover, their utilization rates are not clear, because no one knows the effectiveness of the new technologies in supporting the work of professionals, newspaper reporters, and scientists, to name a few occupations that might use them. As the office of the future evolves and a greater number of individuals engage in computer-interactive work (from a variety of remote locations, including home offices), there will be a need to carefully examine the implications of new interface devices for musculoskeletal disorder risk factors. Globalization Deregulation, inexpensive transportation, and rapid diffusion of distributed computing have driven the globalization of customers, finance, and the production of goods and services (Friedman, 1999). Industry is increasingly spread across more regions of the world. More information is available instantly through Internet technology (Whitman, 1999). Furthermore, the global capital markets are forcing “creative destruction,” i.e., the often brutal flow of capital away from enterprises with low shareholder value to enterprises in which the capital will generate the greatest return. Investments are moving rapidly, forcing industries to respond quickly to changing customer demands. We have moved from managerial capitalism of the first part of this century to investor capitalism with more demanding shareholders (e.g., large pension funds). Even national governments are being forced by the instantaneous investment community to reduce their costs and become more open and transparent. Kanter (1995, 1999) characterizes these changes as greater mobility (of capital, people, ideas), greater simultaneity (of technology or investment informa-

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Page 342tion), greater bypass (other choices besides large corporations), and greater pluralism (with smaller headquarters and decentralized decision making). An important implication of this for the workforce is that workers are increasingly divided into “mobiles” with internationally useful skills and “nonmobiles” who stay in one location and have to accept scarce low-skilled jobs (Kanter, 1999; Porter and Wayland, 1995). One logical fusion of globalization and technology is electronic commerce, or e-commerce (Business Week, 1991). In 1998, e-commerce accounted for approximately $8 billion in retail sales; according to Standard & Poors Industry Surveys (1997), the numbers are projected to increase to $44 billion by 2002. Beyond retail sales, however, is the larger business-to-business commercial sales market that is projected to reach $333 billion on the Internet by 2002. Current users are wealthy and better-educated individuals; however, participation is increasing throughout society. It is anticipated that 40 percent of all businesses will sell their products and services over the Internet in 2000. Using e-commerce, as in traditional forms of direct merchandising, customers can order a wide variety of goods and services directly from producers. The difference now is that a global market structure and the availability of the Internet allow direct customer-producer interactions easily and instantly through a common interface. Some producers sell services, such as travel bookings or information search, for which the delivery process is entirely via the computer. Others sell goods, which eventually must be moved to the location specified by the customer. In e-commerce, customers have direct interaction with the providers, anywhere in the world and at any time of day. Customers can easily comparison shop, leading producers to make rapid changes of pricing and to develop custom products or packages. The direct voice of the customer pushes producers to be highly competitive, highly responsive, and very open; for example, Internet-based real-time tracking of customer orders. These characteristics have a number of occupational implications. First, round-the-clock operations require round-the-clock support. This implies increased shift work, as well as the stresses and satisfaction that may arise from direct customer interaction. Second, the location of support activities need not be related geographically to the delivery of these services. Thus, airline reservation support can be located in rural America (or indeed anywhere in the world) rather than close to an airline's operational hub. Third, in situations in which physical goods must be delivered, a distribution system is required. This often takes the form of a set of distribution centers, again located for geographic convenience, and whose characteristics were discussed in the previous section. Fourth, there is more product variety, many of the products are lighter and packaged by the piece rather than the case, and the product moves through the system

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Page 343from supplier to customer more rapidly. Finally, the extremely rapid growth, and often equally rapid takeover or demise, of e-commerce companies have implications for the duration of continuous employment and the development of workforce skills. An important result of globalization from the perspective of musculoskeletal disorders is that global standards are being adopted by multinational businesses as they try to ensure that they are always ready for future changes. Although many companies still use differences in standards between countries to reduce business costs, more progressive companies are using the most stringent world standards as the basis for their global operations (Kanter, 1999). One effect of this is that standards set by a single country may be of little relevance to increasingly global enter-prises unless they are the most stringent. An obvious example is the ISO-9000 series of quality standards that have had a great leveling effect across different nations (Kroslid, 1999). Organizational Structures, Policies, and Procedures As already noted, technology, the rapid growth of Internet business, and globalization have had a significant impact on how work is organized, managed, and performed. Key organizational changes that can influence the nature of work include downsizing, flatter managerial hierarchies, more teamwork, and greater movement of employees across companies and occupations. Downsizing For industrial workers, major overall results are job loss in developed economies, temporary jobs, longer hours of work, more people with two jobs, and subcontract jobs instead of regular employment (Rifkin, 1995). Global competition has forced many companies to downsize their workforce to remain competitive and increase shareholder value. Budros (1999) examines the reasons for downsizing as separate from reorganization. He sees the downsizing trend as being caused by technological innovation, by the existence of highly paid long-term employees, and by the primarily financial orientation of chief executive officers. Possible negative effects of downsizing are increased workloads for those remaining and increased error and injury rates resulting from the removal of company expertise. For example, downsizing combined with just-in-time manufacturing may lead to workers being asked to perform more jobs and a more variable set of tasks over varying amounts of time. All of these factors have the potential of increasing physical and psychosocial stress. More jobs are being created in small to medium-sized enterprises than in large companies (Budros, 1999), although the major employment

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Page 344sector is still businesses employing over 500 people, accounting for 41 percent of all employment (Rifkin, 1995). The increase of small to medium-sized enterprises can mean more workers who are without the benefit of extensive services, such as onsite medical or ergonomics programs. It also means less unionization, down from 33 percent in 1955 to 16 percent in 1995 (Whitman, 1999). In addition, many operations are being outsourced, leading to reduced levels of job security and more temporary jobs (Whitman, 1999; Budros, 1999). In fact, layoffs in U.S. industry peaked in the period 1992 to 1995, at a time of maximum job growth. The fastest-growing category was in temporary jobs, which rose sixfold between 1972 and 1995 (Whitman, 1999). The total number of temporary jobs is still small; however, it is a major concern of workers (Kanter, 1995, Chapter 6). However, temporary employees may have less access to medical care than is provided by established employers, potentially decreasing early diagnosis and treatment of musculoskeletal disorders. Length of the Work Week Some analysts suggest that work hours overall may be increasing in the United States. For example, Schor (1991) analyzed national data on long-term employment hours of work, vacation time, and work in the home, concluding that total hours of work increased by 9 percent between 1969 and 1987. While her data and analyses have been questioned, many people say that they are working harder than they did before, particularly with the advent of telecommuting and the extensive use of computers at home. In a recent study, Jacobs and Greerson (1998) found that men in professional and managerial careers are more likely to work 50 hours or more per week than men in other occupations and women in any occupation. These data are based on self-reports. Still, the length of the work week has remained constant since 1990, at approximately 34 hours, for nonsupervisory workers in all private-sector jobs (Bureau of Labor Statistics, 2000a). Work hours in the goods producing/manufacturing sectors have also remained constant at approximately 41 hours, with an average overtime between 3.5 and 5 hours. Those workers with the highest number of hours are in the motor vehicle and equipment category and in the primary metals industries category (44 to 46 hours per week). Long working hours, particularly in manual labor jobs, can lead to fatigue and greater exposure to musculoskeletal disorder risk factors. Rapid Obsolescence of Skills and Knowledge Increasingly, work at the world-class levels demanded by global competition generates greater worker skill requirements and greater rate of

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Page 345worker knowledge obsolescence. Kanter (1999) shows that even in manufacturing, physical assets represented 63 percent of company capitalization in 1982, but only 38 percent in 1991. The remainder of the assets is largely composed of company knowledge and competence. Indeed, Siemieniuch and Sinclair (1999) show that even if useful industrial knowledge has a half-life as long as 10 years, only 6 percent of the knowledge at the start of a person's working life will be useful at its end 40 years later. When the current workforce retires, it will be producing unknowable offerings (goods and services) for unborn people with uninvented techniques. In turn, this creates a demand for lifelong training. Whitman (1999) notes that companies with a heavy emphasis on training show a 19 percent greater productivity gain over a 3-year interval than other companies. From the viewpoint of musculoskeletal disorders, the implication is that jobs will be more variable over time, thus increasing the variety of any risk exposure. Sociotechnical Systems and Employee Participation New forms of organization based on sociotechnical systems concepts are being introduced into many industries, both service and manufacturing (Taylor and Felten, 1993). These involve a more complete systems analysis than is typical in many business change practices, such as business process reengineering (Hammer and Champey, 1993). Note that the same modern business practices appear to be employed by companies of different sizes and in different sectors (Waterson, 1999). Sociotechnical systems specifically involve the entire workforce in analyzing both the technical system (to find the key variances in the process) and the social system (to find how these variances are controlled). Such reorganizations have been effective in a number of industries and should reduce musculoskeletal risk exposure by the active design of jobs, rather than by assigning to human operators the tasks left over from a mainly automated system (Bainbridge, 1983). Batt (1999) measured the effects of sociotechnical systems as well as total quality management approaches to customer service representatives in a typical service industry and concluded that only the sociotechnical systems redesign had a large and positive effect on both quality and productivity. The Shift Is from Manufacturing to Service But Manual Labor Jobs Remain Manual materials handling jobs are moving from manufacturing to service/delivery organizations as more repetitive tasks in production systems are automated. When there is little variability between task cycles,

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Page 346automation can be accomplished relatively easily. For example, moving pallets up to the end of a production line for loading and moving on is relatively straightforward. In such cases, workers will no longer be exposed to the lifting tasks common before the introduction of automation. This can reduce musculoskeletal disorder exposure in manufacturing sectors. However, in the service industry, the tasks are more variable. Maintaining a copier, lifting an elderly patient, restocking supermarket shelves, and order picking in a distribution center all involve humans as the prime agents to move materials, mainly because the item-to-item variability is too high for simple automation. Thus, exposure to musculoskeletal disorder risk may be increasing in service industries even as it declines in manufacturing. The high variability of manual materials handling tasks in the service industry provides some variety in postures and loads from cycle to cycle. This may reduce exposure, but at the same time it reduces the task-specific skills of workers, potentially exposing them to more unexpected loads for which they have not been specifically trained or for which they are not well adapted. SUMMARY A central theme for work in the future is the diversity of jobs and workers. As a result, the workplace risk factors associated with the occurrence of musculoskeletal disorders of the upper extremities are expected to increase. In the office, there are many jobs that will require interaction with computers, which can expose a greater fraction of the workforce to keyboards, pointing devices, screen glare, and sedentary work at a variety of workstation configurations. In industry, the quick turnaround demands of e-commerce on distribution centers will involve the rapid movement of a large variety of relatively lightweight products. Workers will be picking pieces and assembling custom combinations rather than handling products by the case load. Trends suggest that the risk factors associated with heavy manual lifting jobs in manufacturing are projected to decrease, but this may not be true in other sectors of the economy. There are many jobs that will still involve heavy or repetitive work—construction, meatpacking and processing, nursing, parcel handling and delivery, picking and placing of parts, etc. However, whenever possible, the trend is toward automation. In industry, this is resulting in the large-scale automation of storage, retrieval, sorting, and delivery tasks. Such tasks can increase the exposure to high-frequency manual materials handling but with lighter loads. Continued long working hours and the increasing requirement for shift work (with round-the-clock e-commerce demands), particularly in manual labor jobs, can be expected to increase the opportunities for fa-

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Page 347tigue and exposure to musculoskeletal disorders risk factors. Also, psychosocial stresses are expected to play a greater role in the workplace of the future. Most workers will be more closely involved with customers, as consumers increasingly demand a combination of high quality, customization, and low price. Exposing the workforce to customers will change the skill requirements. Customer involvement can increase job satisfaction, but also it can increase performance pressure. As jobs become more variable (with repetitive tasks being handled by automation) and are based on new manufacturing paradigms (just-in-time, etc.) there will be a need for flexibility and a pressure to produce on demand. Furthermore, some workers may experience more isolation as support activities are housed in remote locations. More isolation may also occur as computers take over more of the functions that have traditionally relied on human interaction. These trends have implications for an increase in the role of negative psychosocial factors in reports of illness or injury in the workplace. Other factors contributing heavily to the psychosocial environment include reduced job security, more temporary jobs, and outsourcing. There is a prospect that more workers will lose traditional benefits. More jobs are being created in small- to medium-sized enterprises than in large companies. This shift means more workers will be without extensive medical or ergonomics programs. It also means less unionization. The changing composition of the workforce will probably require different workplace conditions. As more women enter the workforce (particularly in materials handling jobs) and as the workforce ages, there will be a continuing need to evaluate work tasks—particularly those that involve lifting, lowering, carrying, and repetitive motion. Finally, with continued globalization comes the increased need for international design standards. A current example is the ISO-9000 series of quality standards, which has had a great leveling effect across nations.

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