 Welcome to Safe Work Australia's virtual seminar series, I'm delighted that we have four international experts to actually assist us with our questions today and I might start with Claudia, would you mind introducing yourself to our Safe Work Australia's audience? Thank you, I'm Claudia Moreno, I am from the School of Public Health, University of Sao Paulo, Brazil. I am a professor there and I study circadian rhythms, sleep and some diseases among shift workers and the work population in general. I'm Drew Dawson, I'm the Director of the Appleton Institute at Central Queensland University and we spent about the last 20 years studying the effects of shift work and fatigue and in particular we're interested in the impact on accidents and injuries. I'm Hans von Dangen, I'm the Director of the Sleep and Performance Research Center and a professor in the College of Medicine at Washington State University in Spokane in the United States and my research focuses on sleep deprivation and circadian misalignment or what it is like to be a shift worker both in the lab and in the field. I'm Ziane Boivin, I'm the Director of the Center for Study and Treatment of Circadian Returns, Douglas Institute, McGill University in Montreal and I'm studying the impact of circadian misalignment or disruption of the sleep wake cycle on physiological rhythm and its application to shift work and also fatigue in the field for shift workers. So you can see we've got a very impressive lineup today to talk to but Drew before we begin into the questions we're sitting here today at the 23rd International Symposium on Shift Work and Working Time at the lovely LaRue Centre that you've got us here too. Please can you tell us what is this symposium that you have arranged? Well every two years or so around about 100 to 120 people interested in the effects of shift work and treatments for shift work get together somewhere remote and exotic in the world and the idea is to share with a group of academics, industry partners, regulators, what's the latest research in shift work and what we can do to minimize some of the problems that have been identified with shift work. Fantastic that's great so I might start with you if I could Dianne so for our audience what do you mean when you're talking about shift work and working time? You can answer that question on two levels first on the organizational level it means group of workers would alternate at a given position and in France we see travail postie means that you're at a position and you rotate group of workers. At the individual level it means that you will work or end up working outside of the conventional week daytime hours so and often it involves working during the nighttime period and there's all sorts of organization either it's permanent or a regular night shift or it's rotating or you can pretty much observe a lot of organization of work throughout the Dianne's organization or have a regular shift being on call and so on so these are a typical work schedule. Thanks Dianne and Hans this so the working times and shifts changed in the last 30 years or are they that's still the same? Well they've changed in a variety of ways I think first of all we've gone to an increasingly 24-7 oriented economy and society so the burden of society on people to work at all hours of the day has increased ever continues to increase ever and ever what I think is an interesting observation to make is that the way we try to manage those hours from a regulatory point of view is starting to change as well and if we go back to the beginning of the industrial revolution and all the way through the past century we see there's an emphasis on regulating work time in other words putting maxima on how long you can work and putting minima on how long you should be off of work before you can rotate back into the workforce. What we're seeing nowadays is a tendency towards regulating not the hours per se but the level of fatigue that is associated with those hours and trying to put a cap on that level of fatigue so that you try to minimize the number of errors and risks that are associated with fatigue that enter the workplace and that's a whole different kind of way of looking at the problem it's much more dynamic and instead of just counting hours what you're trying to minimize is the effect of those hours as they have on performance and safety. Do you have the working hours in Australia changed or do they reflect international patterns? Well a bit of both if you go back 20 to 30 years in Australia you will have found that there was probably half a dozen rosters that will be worked around the country now there are literally thousands of different rosters for many Australians the changes in the industrial landscape over the last couple of decades and in particular the shift of negotiating shifts from our government unions and the industrial court to a situation now where it's typically negotiated between the employer and the employee at the local site means that we have a lot more people coming up with a lot of different rosters the other interesting aspect of that is often people are designing and approving rosters with no expertise or knowledge about it and as a consequence sometimes short-term productivity gains for the company or income issues for employees tend to dominate the discussion rather than the health and safety aspects of it. Claudia in your introduction you told us that one of your expertise areas was in circadian rhythms that I wonder if you can I understand that means our internal body clocks I wonder if you can just unpack that a little bit more for our audience about what is our internal body clock and why is it important? Well it is important because we are diurnal so we are supposed to sleep during at night and be awake during the day and the problem is since the body is has functions that are predetermined by during the evolution as diurnal this means if you inverse your work schedule you have health problems and it's important to understand that to do a task at three in the morning is not the same as a tree in the afternoon and this has consequences on performance on health in general and can also lead to a number of disease and I think it's important to understand sleep has to be has to be according to the individual's needs so some people really need to sleep more than others and this is not possible when you have quicker returns to work or you don't have days off enough to recover your sleep depth during the work week I'm not actually open to all of you because I know you're all researching in this area but are there big differences between individuals you know I've been hearing some comments over the last few days at this meeting but perhaps I could ask you to tell me about the individual differences and are they do they really matter? Well I think tremendously however it's a point where we need more research because we understand very little the individual determinant that will make someone more vulnerable or resistant to shift work or sleep deprivation and or on developing long-term medical consequences associated with shift work and I think Hans has a very nice data also to share about resistance to sleep deprivation yeah so so one of the things we know is that people differ in how they respond to sleep loss and to working at odd hours in a systematic manner in such a way that we even think it's a trait or possibly genetically determined to some extent so that that is at the sort of early morning person that's that's an aspect of it it's also some people are much more resilient to just not sleeping as much as they really should and some people are very vulnerable when they even lose about 10 minutes of their normal sleep you immediately see the consequences the interesting consequence of all these differences is that with more flexible or more variable work schedules there is in principle a better work schedule for every specific individual and if we could just match the individual with the work schedule shift work might not be as big a problem as it is today but because we we we put people in shifts that are not in alignment with their normal rhythms or not in alignment with the amount of sleep that they need we then put them in a situation where shift work becomes a problem and and this pertains to night shifts but it also pertains to early morning shifts if you're a person as going back to this morning as evenness a thing if you're a person who is not a morning type and you're forced to work in early morning hours that is as much shift work for your particular specific individual as working a night shift for somebody who's not an evening type one hour so true what are health consequences for shift work for people with being they're not suited or even if they are doing it most of the time it's a very controversial area peter and and and i suspect this is not going to be a satisfying answer to a lot of people which is we have some preliminary data that shift work can cause health problems do we know the exact mechanisms of action and what's happening at the cellular level no we don't but i think you could probably think of the health effects into a couple of broad areas we know that there are profound effects of shift work on food metabolism and how we process food and at certain times of the day certain types of food that we shouldn't eat seem a lot more attractive than at others i think we're also starting to see some good work showing that shift work particularly where there's sleep loss has impact on the immune system so there's been quite good animal and human studies showing that you can be more susceptible to infection and you can take longer to recover when you've been a shift worker but i think there's also a lot of social consequences that lead to potential health problems so shift workers often eat worse food they exercise less traditionally they have smoked cigarettes more have drunk alcohol more so in many cases we see some of the short-term coping mechanisms for shift work also leading to long-term health consequences for shift workers but again this is a very new and emerging field and one that's going to require a few more years of careful research before we start raising the red flag so to any of you are there gender differences i mean women the same are there age differences i'm thinking about times when i've had adolescent children and there's sleep needs so are there well there is the de sex difference is very important issue and there are recent evidence showing that the way the circadian systems or our body club controls sleep differs between men and women and we know that there are receptors to sexual hormones within the body on the master clock so receptors to test us there on so just tell people what the master clock is oh the master clock is a tiny little structure in the middle of the head at the base of the hypothalamus we call it the supra chiasmatic nucleus you can throw that out during a party it looks good but it's tiny structure and it's like a conductor the master component of the circadian system so our system of body clocks because we know there are several clocks now but these are really sensitive to sex hormones and and the way and control a lot of function and rhythms throughout the body and so important that we have to study the sex difference and there's some evidence that women could be physiologically more susceptible to being sleeping during the night and so we need to pursue these question about the influence of sex of age individual differences and but that's a great question can i add something about sex difference because i think it's not only sex differences but it's also gender differences what is the hold of women at home or men at home and this means if you have problems to be awake at night you also have problems to sleep during the day if you have to take care of children and to do domestic tasks so this can also have an impact an important impact on the adaptation of these women at work and it's a physiologic problem but it's also a social problem and hence is there age differences yeah age differences especially in shift work are very prominent are very clearly and easy to find the general tendency is that as people get older they have more difficulty adapting to or tolerating shift work there's a variety of reasons for that it's the natural aging process but also the responsibilities that people have when they get older their life situation tends to change and so it's a consolation of factors that we haven't been able to tease apart very well but we know that in general it becomes harder and harder as you get older to be a shift work and actually function well or or deal with the circumstances so you've been talking to me about the gender differences and the age differences and some family who's doing the caring at home Andrew you touched on the health consequences I'm wondering about what about the are there safety implications in terms of increased accident risks or not is that a myth yeah I think there's been a lot of work in the last few years and I think we now understand that people who work shift work get less sleep people who get less sleep are tired and people who are tired make more mistakes and if that happens in a workplace they can injure themselves or others and I think there's a pretty solid basis for making that conclusion now I think the interesting thing however has been the tendency in the past to think well the obvious solution to people being fatigued is to make them not fatigued and that somehow we will change their rosters in a way that fatigue will go away as a problem I think we've matured a little bit in the last decade or two and we've now come to the realisation that if you work 24-7 even if you get a decent sleep you're always going to be tired at four o'clock in the morning and I think we're moving from a culture and a safety mentality that says fatigue is a problem let's get rid of fatigue to saying fatigue is a problem how can we get people to work safely whilst fatigued and I think a lot of the development in the last couple of years has been to say let's identify people who are fatigued and then let's rethink about their job and how they do things and who knows they're fatigued so that tired people can deliver healthcare and emergency services and those kind of occupations because frankly the inability to not provide the service politically has meant that people have pretended that fatigue's not a problem and done very little about it so we're leading into one of the questions that I think will be of great interest to the audience so it's what can employers be doing in order to help accommodate tired workers if you're saying it's a reality that some workers will need to be working even though they're sleep deprived and I'm opening it to the whole panel here well from our experience in Australia and that may not be universal around the world the biggest and the most important step is to get the organisation to acknowledge that fatigue is a problem we we often say that fatigue is a forbidden topic of conversation don't mention it because it'll cost us 10 percent in the next EVA and our experience has been that once organisations choose to talk about it and see what they can do to manage the risks a lot of that can be identified and you can develop quite sensible practical ways to reduce the risk if not always changing the roster so I think first step is to start talking about it yeah I think opening the dialogue up and saying fatigue's a problem let's talk about us let's share what the silly things people do when they're fatigued and let's see if we can redesign the system so even if people are tired those mistakes don't necessarily cost lives so Deanne and Claudia enhance what are some of the things that employers can do to be redesigning the system to deal with this reality that some workers will be fatigued well like Drew mentions very important to recognise there's a problem an issue and to realise that there's no perfect solution the risk zero do not exist so first recognise it if you want to manage it properly and the other message is that one size doesn't fit all it's a complex problem that needs to be approached by several different directions in order to mitigate its risk properly and one recommendation may work very well in some environment for instance oh let's try to adjust the body clock of workers to revert to a night-oriented schedule with interventions such as light it could be okay in some situation but not at all in others and but there's some general principles such as try to sleep as much as you you you can I think these are you know avoid on the daily basis sleep restriction or the build-up of sleep that as much as you can but there's needs to be some flexibility to accommodate the various situations so hence some practical suggestions for Australian and international employers about what they can be doing to make work design work better yes I think if you go to the working time arrangements that are currently in place so you start to look at how do they get to be the way they are you oftentimes find that they are a complex mixture of of of of interactions and decisions being made by regulators by managers and by by employees or unions or labor and management regulator triad and and so when you talk about what can employers or what can employees or what can regulators do to help with fatigue in the workplace you almost always enter that that triad that that that complex interaction and have to start negotiating that problem from a more holistic point of view and that can under certain circumstances be very difficult or controversial to do depending on the on the relationships that employers employees and regulators have to with each other to begin with it turns out however that when you start talking about fatigue and you spend a little time with the various different parties that are involved and you start digging to dig into that topic a little deeper did you find that at the end of the day pretty much everybody wants the same thing everybody wants less fatigue in the workplace more safety in the workplace and if possible also more more productivity and these things are not orthogonal so what I found is that to to to make progress in this area if you can bring the various parties to the table and get them to understand that what they really want is all the same thing and start the dialogue from that perspective then then it turns out that the working-time arrangements and all the complexities that went into them can also be rearranged with a common goal in mind that makes it better for everybody maybe not perfect for anybody because perfect is oftentimes the enemy of the good but you can make progress and you can make improvements so your point is that consult with everybody including the workers and of course in Australian legislation that's actually a requirement so and I just went to add to workers part the workers side their families it's very important to involve the the families because the work himself or herself cannot do nothing alone so it's important to involve the families as well the employers the government the regulators and the workers if you start from the regulation you don't you will probably not reach the the workers and so you need to start together with the workers and their families to support them and what are some practical things that families can do go ahead okay well your comment Claudia also raised the concept of shared responsibility so everybody has a responsibility to manage fatigue correctly like like the the the worker they should use up their rest days to recover the sleep death the manager they should offer conditions that allow workers to recuperate between the shifts and the family also they have to realize well I live with a a chef worker it has consequences so when the person wants to rest you need to protect that risk and so as part of this process education is extremely important and I think all levels of the organization of the family you know if they can get educated on what are the challenge of working on a typical schedule and what can each of them do that would help tremendously so I've been hearing over the the course of this symposium drew about some of the new technologies and interventions that are out there and I wondered if you might talk about some of those and perhaps our other panelists as well I've heard about things like bite therapy or using melatonin does any of that work is that something that people should be thinking about well I think to come back to Deanne's point is that there are a lot of things that you can do but it isn't a one size fits all in fact it's a one size doesn't fit most situation and I think what one of the key messages is that we have seen a shift in the last 10 years and up until about 10 years ago the primary control mechanism was the roster and discussions around the roster I think we've seen the emergence of a whole set of new wearable computing in cab monitoring technologies there's a whole set of very slick fatigue gadgets as they have sometimes referred to us and I think they have enormous potential to help with fatigue but I'd also raise a cautionary note that often in some organizations they're seen as a silver bullet that's going to solve the whole problem and to come back to Claudia's point is it takes a family to support a shift worker and sometimes the appeal of a piece of technology can override the more difficult but more important things that have to be done in terms of the employer's responsibilities the family and community the regulators so I think we're going to see much more sophisticated systems as a result of technology but I'm also cautious that sometimes they can be very appealing without necessarily having the evidence to support their effectiveness Deanne and Claudia and uh-huh so if you've got any comments about the new technologies or new techniques that might be useful or a myth that they may help well in my case I have been studied truck drivers for the past 10 years and I can say we need to work more on that we we didn't find a very nice technology to help them to really identify when they are sleepy and what they should do and I think this is mainly because what they should do is to sleep and what the employer wants is that the truck driver reach that or deliver that goods uh on time so this is a kind of uh controversial situation and uh so we need to do these things together technology and the support of the employer I mean in order to make the technology work yeah and I I share the the same opinion and if we look at uh if we look at for instance technology that can predict or evaluate the fitness for duty I think they they can create a false sense of security let's say for instance you you have a worker arrive at the start of a night shift the alertness can be pretty high and he can be fine at that time but had he known about the circadian the the way the body clock controls alertness he would know that at that time of day maybe alertness is high but it's going to dive into uh low points at the end of the night and the challenge is that these technologies should aid in uh controlling fatigue at work but they cannot be the solution because uh when the fatigue levels are too high maybe it's too late also so you need to mix education and discussion and have group of of employee at various levels within the organization and especially higher level management should embark on this fatigue management initiative I think one of the tricky parts is when you put technology in the hands of people that can freely obtain and use it that you have to be careful about the tricky parts of human behavior there's this anecdotal example of of uh truck drivers who have drowsy driving warning systems in their trucks and notice that they are being alerted to drowsy and they decide that obviously they need to have sleep and therefore they start driving faster to make it home sooner which is the exact wrong solution to the exact right identification of a problem and and and so what as with so many aspects of human behavior um we we know the basic principles but how it actually plays out in practice is something that continues to be a uh a topic of research and it's really complicated so I think we're beginning to run out of time so I'm just going to ask all of you to give one concluding practical suggestion for our viewers on what a worker or an employer can be doing to actually minimize the the health and safety consequences of fatigue I'm going to go for the cultural one and say it's okay to talk about it and that if we have that dialogue we should be able to solve the problem and it doesn't always require high tech solutions just knowing that the person you're working with is tired will change the way you observe interact and regulate their behavior and we see that kind of stuff happening in workplaces all the time so I think there's some very good low tech solutions that come when people think it's okay to talk about this topic and to share with others when they are fatigued and particularly with their managers and people within the organization who are responsible for managing the safety of that organization well I think I I could say a number of things but uh I I go for the dialogue as well I think it's more important to think about education programs that can actually be done in companies with employers and employees and also link this to the research world I mean this means this needs to be closed very close we need to work together the university researchers the companies and the real world I think this is the most important thing okay yeah I agree with all that is said and it's important to talk about it but also to do something about it and you know we're researchers scientists we know the problem we try to transfer the knowledge but probably the solution will come from the workplace environment so what do you do with this uh observation about fatigue what can be done what do you do if a worker says oh I think I'm too tired I'm not fit for duty you need to start thinking ahead of time of alternative scenarios plan B a B plan sorry and and the make sure that you are proactive as an organization and have an open dialogue and and none you know make the workers feel that they can discuss that issue and and that something is going to be done about it so we tell people people like myself will tell people that it would be really great if you could sleep eight hours and if you could do it in the night and you could have a regular schedule and all those things that in shift work settings are basically pretty much impossible I think the one piece of advice that I would give is be aware of the simple but perhaps not correct solution we have a tendency to ask just tell me what to do just tell me how to solve this problem and both from the research perspective and from the organizational perspective we don't necessarily have all the answers yet which means that we don't we we cannot necessarily give you a one-size-fits-all answer to those complicated questions but I would also suggest that sometimes the answer has already been found sometimes the answer is already in the organization in the individuals they've already come up with a solution to make things work so is that things like having power naps or having better lighting yeah so or yeah so so sanctioned napping in the workplaces can be a really good solution it depends on the workplace and in some workplaces we find that really works really well computing where where you share rights home to increase safety is an example of that so people have found solutions that can in their particular circumstances be just perfectly fine and I would suggest that yes there's always room for improvement but don't throw overboard the things you've already figured out that actually do work you make me think about something which is very important that people often they keep the model of a day of a normal day oriented schedule as a goal to achieve let's say try to sleep in one single sleep episode and go as close as we can to you know normal behavior actually this can be quite detrimental in some work organization and the model that you have to sleep in one single period can actually increase fatigue so it's okay to have split sleep schedule that can actually help you go through your work roster with minimal alertness impairment and so you have to think outside of the box basically it's more important to get the amount of sleep even if it's not all in one go exactly thank you very much is there anything some any concluding comments that you want we've heard about a little bit of a pound napping there I hear this really strong message about the need there's no silver bullet it's about getting enough sleep I hear a really strong message about talking with our workers in the workplace and trying to identify some practical solutions because ship work is with us whether we like it or not are there any final concluding comments that you think that we should be taking home today again going back to the notion of dialogue it's really interesting when you go and talk to organizations and say tell us the dumb stuff you do when you're tired and just having that conversation so people can then work out how to rework the workplace in ways that stops those errors happening health care emergency services defense are all full of examples of where people as Hans has pointed out are already doing things to manage fatigue well but they're not formal elements in the safety management system and in many cases they're procedural violations despite the fact that they're making the place safe that sounds like that's a topic for another conversation I'd like to say there is not a single solution although we are discussing this in an international meeting there is not a solution that can fit every country or all companies different places different categories of workers and we need to understand that it can be different depending according to the case and this I think it's the my final message thanks very much what's the role of the health and safety representative and do they need more information about health and safety consequences of shift work and long working hours yeah I think that's an excellent question and and just like most other aspects of learning a business it's an expertise that is required to be a part of the organization to function fully just like a bookkeeping and your engineer and your building manager and all these people that have certain expertise this is an area of expertise that needs to be brought into an organization that is based on shift work and and so if there is a person or department where that has a natural fit it stands to reason to make sure that these people are educated on the topic and that they can propagate that that knowledge towards the workforce now I would also submit that it's that obtaining that knowledge is not something you can just do overnight that requires some training and as we've already discussed in this panel there is some research that is starting to evolve but isn't really sorted out yet and so I would submit that with Drew having brought together here 100 or so experts in the world maybe designated people in organizations can start to reach out to to people like us so that we can then propagate the research and the knowledge base to the organizational officials that they can subsequently translate it to the actual workplace so I'd just like to I've heard a question from the audience which I think this is an excellent one quite a challenging one is what's the role of your group to actually feed into groups like the ILO in terms of informing international conventions on working hours that's a really difficult question Peter and it's it's the $64,000 question in a sense one of the challenges is that regulatory agencies around the world often try to come up with a one size fits all solution and we have enough trouble getting a one size fits all solution in one organization and one group of workers let alone something that's going to cover everybody all around the world so I think the goal of groups like us is to focus people on letting go of prescriptive approaches to legislation I think promoting performance-based regulatory frameworks is very important but I'll also make the comment that global and UN based regulatory bodies are not embracing performance-based regulation or legislation just yet and I think that's a very slow global process that's going to take decades from its birth in 1972 and the Robins reforms in the UK I suspect if we come back in 2072 we might start to see that but I suspect like most things at a global level it takes a long time and I'd be interested in the other's views from different cultures I think Australia and English-speaking countries in general have pushed very rapidly into the performance-based approaches especially to fatigue but I also know in other countries that's not popular and I know many other countries where the idea of regulating shift work and fatigue is the least of their problems and they're more worried about a host of other problems before we worry about a few tired shift workers yeah and also to add to Drew's comment what is important is not only considered the work roster the work shift organization but also the workload because if the workload is low and the risk associated with being fatigue at work is low then the work hours can change and these needs to be taken into consideration and so arriving with international guidelines that should be followed would I think put organization at disadvantage in terms of flexibility and really recognizing and mitigating their own risk so they have to be adapted to the nature of the task the nature of the organization and and there needs to be some flexibility I'd like to thank you all for joining us today in this panel discussion and I look forward to meeting with you all professionally on another occasion