 Welcome back. We now have Associate Professor Anjum Naweed from Central Queensland University who will present on derailing workplace MSD risks through systems thinking, which is front and centre of our theme today. Anjum has over 15 years of experience across a range of industry sectors, complex domains and occupational settings. He has a PhD in Applied Cognitive Science and is a certified professional agonist. Anjum has co-edited books written in more than 100 peer-reviewed articles and secured over $3 million in research funding. He currently serves as a scientific editor for Applied Ergonomics and has been a scientific convener for the Australasian Simulation Congress on four consecutive occasions. Great to have you with us Anjum. Welcome. Thanks for the honour. Just following on from Sharon's presentation, I think it's going to be very hard to follow because it was so good, but I'll do my best and really hopefully give you a nice case study to think of in the context of the rail environment. So this is where I work. This is bottom of fair. My director, Professor Sally Ferguson, we're down at the Appleton Institute, which is the Adelaide based campus for Central Queensland University, which has a large national print as you can see on the screen there. And we do lots of stuff in the area of behavioral science and in a very applied context. These are the sorts of areas that I tend to do my work in. I'm very interested in performance systems thinking and theoretical applications, really, to real world problems. Most of my work does tend to be in the transport space. Hence, there is one focusing on rail and also why I've got a very familiar infographic style here to show my various areas. So, yeah, it's very much something that I focus a lot of my research on. I work in the area of operational readiness. That's the sort of theme that I'm performing my work most. And this is an indication of the most at risk occupations for mental health injury or injury susceptibility from Safe Work Australia. And you'll see here that along with prison officers and welfare community workers and so on, we have bus drivers and rail drivers. Now, bus drivers and rail drivers are also noteworthy as a body stressing occupation. And so therefore they're at risk of work related to musculoskeletal disorders. And so that's the reason I guess why there's a full spectrum of focus that's needed really in this particular cohort. And also one of the reasons why I really enjoy researching in this area too. So just moving on then, I want to talk to you a little bit about research that I've done in the area of light rail. That's trams or street cars. So anywhere where you've got trams, you're familiar with the way that these work. I'm sure most of you have probably ridden trams, if not in Australia, then around the world. And, you know, the topic of musculoskeletal disorders in the context of driving these very large vehicles. So just to give you a bit of an overview then, I'll be talking a little bit about MSDs in this sort of context. I want to talk a bit too about the characteristics of the task before jumping into the study that we did. I'll give you a bit of background on why we did that study and then also talk to you a bit about the mixed methods that were involved. This is an acknowledgement page for my co-authors. Most research doesn't happen in isolation or with one person. So I want to acknowledge Lorelle, Josh and Caroline for their involvement in this research. Caroline now is working at Federation University and Josh is at Flinders University. And Caroline is also a professor, a premium scientist in occupational therapy. So the background for this study then, well, a tram organisation approached us, approached me, indicating that approximately 20% of their driver cohort was on sick leave and on light duty. So they weren't driving as much as they would ordinarily with work related MSDs. And then the cause that they attributed themselves was to the design of the master controller. What that is, I'll explain to you in a bit. And they were developing a business case to remove the current master controller and reinstall a new proprietary design under the assumption that's going to deal with some of these work related musculoskeletal disorders. And so we embarked on a multi-method, sorry, mixed methods study in two different parts, well, two parts of the first study in one part for the second one, but it was conducted over time. And what we thought of all the way through this was the relevance of systems thinking in prevention to try to understand the myriad of factors that might be causing these and whether, for example, replacement of a master controller is actually going to deal with it or not. Before going into the meat of the work, I just want to give you a bit of background on what human factors in the light rail looks like. So if you look at the slide, you'll see sort of a flow diagram starting here with the tram and the driver and going all the way around here. What the tram and the driver does, as you can see, is they drive according to what they can see outside the window and also the speed information that's provided in the cab, what we call real world target tracking. They then monitor the environment and they use essentially proponents of situational awareness to establish the current state and anticipate what they need to do for the future using a variety of external information to inform their throttle control. And then that dynamic control is also underpinned by the driver's own knowledge base, understanding of the rules, standards of work, the route itself and how the tram works. And this sort of cycle continues. So what is a master controller? A master controller is the lever, I guess, as you guys understand it, that's found in the cab, the lever which propels the tram forward and back. So just to break that down, you can see a hand of the driver on there on the master controller. When you push the master controller down, you activate a dead man device. Now, what that's a terrible euphemistic word for what this is, but that's what it's called. Essentially, in order for the tram to know that you haven't collapsed under your operational, you've always got to keep this master controller depressed and it requires sustained force. And then that sustained force is also applied in the forward or in the backward direction. Okay, the backward to slow down forward to speed up. So you've always got to keep down a certain amount of pressure. The other thing is that this dead man, sorry, this master controller is interlinked with a vigilant system. So as well as keeping it down all the time, the system is designed to monitor whether the operator, the driver has actually collapsed or not, you know, it's possible they may have collapsed and the weight is pushing it down. So it checks after every sort of interval, whether the driver is alert or not. And what you've got to do is you hear a sound going off in a cab, and you've got to lift the master controller will do something in the cab to indicate that you are, you know, you are alert, you are still conscious by lifting it up and putting it back down again, or you might be able to interact with something else in the cab. But the understanding really for us was that you would actually have to lift the master controller up or down. And so that may happen in intervals, we're talking, you know, potentially 10 seconds, 30 seconds, 40 seconds and so on. But, you know, the belief is that it's a fixed interval. These are some images here of people in the, in the, in the tram it's out, you can see pushing forward, pushing back at the top, and then the bottom two images pushing it down and lifting it up. And so we approach this work by thinking about the kind of models that are out there. And this is a really big model that's used in the context of occupational therapy by Christensen and Baum. It's called the Person, Environment, Occupation, Participation Model, or the PEOP for short. And as you can look at it, you'll see that there's an emphasis of the person based on their intrinsic factors, which delves into the applied cognitive areas, but also bringing some of these bigger aspects, the spirituality and so on. On the right here, you'll see all the extrinsic environmental factors, where you have cultures and values associated with economic systems. And so immediately you can start to sort of see, well, this model is actually appealing to a systems thinking view of complexity. In the middle, you can see that these two things converge to actually apply constraints on the structure of the tasks and the actual act of doing the occupation and the performance. This kind of model has been adapted and interpreted in many different ways. And so one example of this is by Cascutas, the model of work performance, where you can see here that work performance and the environmental affordances, work performance reaches job demands in various different ways. It's either insufficient or it's out of balance. So you're not able to sort of reach personal competence or environmental affordances. You just have one or the other. But ideally you'd want it to be sort of fitted completely. So you'd have like an optimised match where the three things are working, work performance and job demands are being met appropriately. So our research design, then, we did two studies, as I mentioned. The first one was very sort of mixed methods in that we did in coal observations and focus groups and interviews with drivers directly in a participative way. And then we did a large cycle social survey to get more import from the other drivers inside that environment, noting that we probably could only get a fewer number of drivers to be involved in the first components. They were obviously driving with, you know, they were operating in a less than ideal context. Some drivers that were off duty or on light duties and so we didn't want to place too much burden on them. So this is the first study and I'll start with interviews and the focus groups. So the interviews and focus, obviously, you know, for those academics among us usually that are interested as a quality of design, we did 10 one-to-one interviews with drivers, a mixture of injured and uninjured drivers, to get a good representation across them. And we did one three-person focus group with all injured drivers, hoping that it would be a scenario where they may feel more empowered to talk and share their thoughts as well as the one-on-one environment. The went on for about 60 to 90 minutes and then we analyzed it deductively, antimatically. So we used the PEOP frameworks there, as you can see, to figure out where a lot of the themes were falling. And I just want to give you some quick sort of indications of where everything fell. So you can see some of the categories here, health management, attitudes, intergroup tension, all these sorts of things were found across the court. You can see the extent to which they were represented. And then we also had the environmental occupation and performance. And I want to give you a bit of a slice of the person part for this one. So if you look, for example, at a prior physical status, red boxes are the injured driver's perspectives and the yellow ones are the perspectives of the uninjured. You can see that the injured drivers felt that medicals tended to be a bit problematic and that lots of people that came into the job skipped through. People were economic with the truth about their own injuries and backgrounds. And then down here you can see into the tram driving there was a perception from both injured and injured drivers that there were problems. You could get aggravations from previous injuries if you've had them. The job itself was at entry and it was an uncommon to feel pain associated with driving and use of the master controller after six months. We're talking wrist, arm, upper limbs and so on. Attitude towards injury, a great deal more going on here. Lots of beliefs from those that are uninjured around. There's nothing to the job physically. We don't understand how injury could be happening. Maybe it's an issue for smaller frame people. This belief those that are injured are actually now picking up extra shifts where the shifts are around and in reserve and they're hanging around doing nothing in them. They're not pulling their weight. There's this perception that the incidents of work related to musculoskeletal disorders, it's bizarre that it could be happening in drivers with a large builder heavy frame. Surely it's just the medium builder like old people that happens to. A lot of stigmatising and silencing happening around perceived by the injured drivers. They thought they weren't able to speak up and so on. And then this created sort of this intergroup tension which led to a belief that the conditions not being accepted by the drivers and feeling invalidated. Whereas the uninjured drivers felt that the accommodations that they were making for the injured were imposing on the well-being and job satisfaction of the for themselves. Health management, you can see a mixture of different things that they did. You know the uninjured drivers tried to stave off any problems by doing a few proactive things. In terms of managing the health immediately you could see that there was a variety of things. But there was also this kind of prevalent notion that they didn't really want to say anything or do anything to the organisation in case it had any implications for their job. So you can see that this became very you know at the individual level became quite a significant problem. And at the top right here importantly with a master control of perspectives drivers believed the stem was too high that the human body is not supposed to interact with the device in such a way. Continuous pressure was half the problem. Then also this belief that the vigilance cycle was too short. About 10 seconds to 20 seconds. So you know the belief that after every 10 seconds the cycle is going to go off and so you know it requires too many activations from us and we've got to push it to regularly. Okay so that's a bit of the information that we've got there on the interviews and the focus groups just looking at the in cab observations. We followed a structured approach here as well. We didn't just sort of want to go and just watch what they were doing want to actually have like a systematic structured approach. So here we observed 11 drivers 600 500 through and their trip. So this was out and back from the depot. We did a 526 minutes in total just under nine hours of footage from each camera. And we use the software called Boris which essentially allows it to map a state or point events. And these were the events that we identified when we were going out. So we were watching for whenever they were pressing the dead man whenever they were engaging it in a backwards position. All these behaviors which were point behaviors in the middle. The difference being the state behaviors are things that are happening with a defined space and time. And then point behaviors actually that are happening just as they are. So you know a marker that this activity happened. For example there was a great change. The state would be the duration of time from when they applied you know the dead man to when they ended it. And so on. More pictures here. You can see the cap at the bottom here. A variation in the way that the master controller is held in different ways. Different positions. Top right here movement to stretch movement of legs leg positions and so on. And the one leg positions and one of the issues that we found was this this um uh pedal button at the bottom here to call the traffic controller right next to where where you put your feet. There was a lot of accidental depressions of that as you can imagine. So the drivers had built you know kind of a habit of keeping their feet away from the foot rest to avoid accidentally depressing it. And then here you can see images of people reaching across the console stretching and so on. So what we found here then after doing some analyses was the following uninjured drivers were more likely to stretch the upper body than injured drivers an average of 1.82 times over 15 minutes whilst the injured drivers stretched less than once on average. Drivers with smaller bills stretched their upper body less than the counterparts with the medium build. And this one importantly on average injured drivers engage in repeated vigilance behaviors twice as much as they as uninjured drivers. So they activated it more than the others. Now what that means is that when the vigilance that there's this belief or there's the vigilance device is going to go off at some point. And so to preempt that a lot of the drivers engage it before to interrupt that cycle so that the alert never goes off because the alert is perceived to be anxiety inducing and punishing actually believe or not. And so there's a lot of depressions happening and those depressions happen more for the injured than they did the uninjured. Let's have a look at this in a bit more detail. So based on the time observations we found that the actual alert did not sound until 30 seconds. But the drivers that were injured as well as some of the others believe that it happened as early as 10 seconds. So you can imagine that that device is going up and down quite a lot whilst your sustaining force. Now this modification occurred two years before the injury manifestation with change from indiscriminate activation to an auto reset. So what they did was they tasked linked it. So every time that you moved it forward or back or you engaged with anything else, it would reset anyway. But the belief was that if this was the original incarnation which just required the depression to go up and down. And so, you know, the injured drivers activated the original device more than the uninjured and in line with the previous approach. Now, let's have a look at the next study, the driver survey. I'll go through this very quickly. I want to talk about all these but essentially we produced a psychosocial survey required about 40 minutes to complete and 44 drivers completed the survey. And there was a lot that didn't want to complete it but 44 did and we had all these measures, these scales here as you can see and the analysis happened, you know, using conventional methods of what go into what they are. But we analyzed for associations across them and we found a bunch of interesting things. We found significant associations that as drivers are less aware of their body are less limited in their workplace or feel less into the workplace when they've got a better work-life balance or when their emotional demands and task load are lower then their general well-being is more positive. Now, this obviously goes without saying. It's fairly straightforward but we found something really interesting in that high perceived belonging support was associated with a lower chance of an injury being present and what that means is that the effect of work intensity on injury status was dependent on the perceived availability of interpersonal support. So have a look at this graph here. So work intensity in the context of train driving, sorry, tram driving is having to work at very high speeds or very tight windows. And you can see here that at low and medium levels of perceived work intensity, aside here on the left, the probability of injury increases with low levels of perceived interpersonal support. So the less that you believe that you have interpersonal support, so support from colleagues, friends, those outside of work, the higher the chance, the higher the probability that you'll actually experience a work related musculoskeletal disorder or an injury. So you can sort of see here this complex picture coming together. So let's have a look at the bigger picture. Previdence of upper body stretches amongst only new drivers. There's a misunderstanding amongst drivers considering the time lapse for the activation of the original system. The amount of the time a driver spends using forward and backward pressure or the master controller in conjunction with downward force in order to keep the dead man system engaged was not associated with the difference in the prevalence of injury. There was an unnecessarily high activation of the vigilance system amongst new drivers, which was a legacy behavior and could be considered injury priming. And when drivers perceived that work intensity was high, it was the drivers with lower levels of interpersonal support that were more likely to be injured. What that made us conclude was that the master controller may be a contributing factor, but it alone is not responsible for injuries amongst the driver. So let's have a look at the system in a bit more detail on the left here. You sort of start off with the vehicle, which has the dead man, the vigilance device, the cabin to face, vibration demands, of course, from moving traction in that kind of environment. Then you have the driver and they're fundamentally limited in these ways. They have to use their attention. They're easily distracted. They've got the quick with their reactions, as you've seen with the vigilance device. It's a sedentary job and requires considerations and fatigue and shift work. They're operating that in an environment where they've got to move a certain way and also a rail infrastructure which is quite sort of technically designed in certain ways and also requires management and maintenance in certain ways too. And that includes the assets, the vehicles themselves like the master controller device. And then you've got the service delivery demands unopening all that, why they're moving, they're running, they're entering to a timetable, a changeable, which can move at different sort of speeds and pressures. Around all that you've got a mixed traffic environment that behaves very differently in an open way so people can access it. It looks different day than it does at night and peak and off-peak and so on whether also affects the drivability of that tram. So behind all this then you have all these these constraints that are placed on the cycle social influences that manifest. So you know with all this drivers have this own goals and motivated a certain way that feel pressures they bet they behave to their own social norms and within the presiding organizational culture but of course all these things collude to create these health impacts which can be very mental in the context of stress and anxiety but also a variety of physical ones cardiometabolic and of course the topic of this conference musculoskeletal disorders. Now if you look at our results which was done in in a mixed methods way something in all these layers is implicated. So it's not just simply a case of saying it's just the vehicle and one thing on the left hand side you can actually see that there's a myriad of collusion including factors across all these that that that behave to actually impose these sorts of issues and the individuals now you know predispositions come into this predispositions predispositions of anxiety predispositions for behaving a certain way come into this course but without adequate support for all these things you know in some ways a musculoskeletal injury or disorder is probably not avoidable. So we then got all that information and adapted it ourselves and updated it into a new version of the POP model just in the context of musculoskeletal disorders for tram driving and light rail and you can see here you know we've we've brought everything in you could vigilance manifests in various ways in the person side and the organisational side and the performance side here as well as all the other things like the intergroup tensions like the presiding organisational culture where a lot of that interpersonal support is important and needs to be found and in this absence you've actually got some issues haven't you we have published this work in safe science which is Sharon's journal and if you want more information please go and download this one this is an open access article more information about the project and if you need to contact me my details in the left there I have a social media presence as well as you can email me directly thank you very much for your attention and thank you for that presentation so much detail I learned so much Anjom thank you plenty of questions coming in and you can log yours in the live Q&A chat on your screen as well let's start with Peter he says if the downward force exertions on the master controller are acceptable would it be reasonably practicable to accommodate those limiting users such as shorter stature operators with elevated arm support they did have elevated arm support and things like that in there but I would just question whether that's a bandaid solution and whether something bigger needs to happen as far as the design of the master controller is concerned well that leads very well into our second question is if you were actually designing a cabin today what would be the process can you walk us through the first steps you would take I don't think I've got all the time to answer that kind of question look if you were designing something from the beginning then it wouldn't be just me designing it would be a large group of people very interdisciplinary looking at specifications and building in some really good you know risk management processes in and recognizing I guess the anthropometric profiles of those people that would be in the canvas okay so can I just stop you there what kind of people give us a guide well I don't really want to sort of say that you need people with a certain build or you need people with you know certain affinities psychologically I think that any kind of job would be suitable for you but I think that in the case of this particular one you've got to recognize that the organization did not tell the drivers that the that the vigilance became task linked and so the injury started not long after so in that context you can assume that perhaps that the you know the the static strength load requirements in the master controller were okay but these problems developed afterwards through these other kinds of papers that started beyond the fact so I think that I think that it's important to recognize who you're recruiting as far as the predispositions go you know we found a lot of these elements associated with anxiety that were injury predisposing but there's nothing to say that the job didn't actually make them anxious and they came into it how do you produce a job that maintains that good mental and physical balance if you will yeah absolutely how did you motivate drivers to complete the survey it was difficult Madonna it was very difficult we had drivers that took part in the first phase as you saw in the second phase because it required a lot of work and there was organizational support to do with the organizational time it was voluntary I think we had roughly probably about a third or half of the drivers completed it in the end so statistical power was a bit of an issue for us what we really needed was as many drivers as possible but in the end it was it wasn't that we were incentivizing them through money or anything like that it was this is a really important issue and we need to understand it and we're just one other organization you know after many that have come and spoken to you please you know know that we're doing something a bit different here and we want you to understand more about what's going on and through that kind of narrative in discourse we've managed to get drivers involved so this is a great follow-up question thank you did this research shift the perceptions of drivers about their own risks? I would like to believe that it did it was all very transparent and it all came out to the whole organization and to the drivers and and you know we were quite open about calling out the cultural elements that were in some ways reinforcing a lot of these problems like you know if you're not feeling you're getting support you're not being validated we found that association didn't we that interaction terms and it was really fascinating how just knowing that you are believer you're validated by your peers and your colleagues might actually reduce your chances of an injury or at least dampen its effects so it ended up being this unusual cycle we wanted to to share that and show that they were all aware of that and we we hope that that was taken on board thank you a question from Lani you're talking about interpersonal support what type of interpersonal support was it from co-workers managers or employers? well it was it was I guess you know are you okay sitting down talking wanting to be heard not feeling like you were being judged how are things going on that connectivity that happens and in the end what we saw was instead of that happening there was more sort of enclaves that were developing in the room separate groups and and you can sort of see there that disconnection was creating a lack of support so it was more the sort of interpersonal how you're going how are things going and looking after them you know by asking about your well-being so important isn't it and you know our theme for the conference is safety by design if I asked you what that means what your perspective on that is how would you answer it? well if people are going to be assigning blame to an artifact in the cab in the context of a master controller and assuming that changing it by putting another one is not going to adversely impact the 80 percent of drivers that aren't affected and cause new problems then I would say that a radical rethink is really required of the way that the tram vigilant system and also the dead man system works and recognizing that these are legacy systems and we need to think about you know how we can adapt them to fit with the driver in a more integrated way than they are currently thank you so much for the honesty of your answers but also the detail of your presentation Anjum thank you don't worry thank you