This study was initiated by the Occupational Safety and Health Service (OSH) of the Department of Labour (the Department). Because of the wider interest that was shown internal and external to the department, OSH invited groups with interests in injury prevention, such as the Labour Market Policy Group and ACC to participate. So, in 2001 the Department and ACC undertook case study research to obtain a deeper understanding of the consequences of injury and illness. While employer’s understanding of the costs of compliance are well documented, the costs and consequences of avoidable occupational injury and illness are not. Further, how non-compliance affects the community is to a greater degree unknown. How costs are distributed beyond the employer and the experiences of those who bear them need investigation. Because of their nature, the full breadth and depth of costs of workplace illness and injury are not recorded in any official statistic.
To explore the social and economic consequences of workplace injury and illness, three objectives were identified:
• to explore the social and economic consequences of workplace injury and illness for injured and ill employees, their families, and the workplace;
• to identify key characteristics that determine social consequences; and
• to inform investment in health and safety in the workplace.
To achieve the purpose of the study, four research questions were drawn from the study objectives.
1. What are the main social consequences of workplace injury and illness and how can they be identified and avoided?
2. What are the key characteristics (for example gender, ethnicity, age, family status, injury or illness type, and location) that shape the social consequences and economic costs following occupational illness or injury?
3. What is the nature and extent of the financial costs (for example loss of income, medical costs) of workplace illness and injury and how can these be valued in economic and social terms?
4. What are the links between social consequences and economic costs of workplace illness and injury?
The unit of analysis for these questions was the ill or injured employee and their relationships in the home, workplace and community. A case study approach, with both quantitative and qualitative methods was utilised. This involved triangulating data from a number of sources including; existing ACC and OSH research, analysis of stakeholder views, and case studies interviews with the affected person their family, workmates, and if appropriate OSH and other health professionals.
An iterative research process was used. The research objectives, the questions, the case study framework, and a participant selection process were developed. From this a literature review was completed, semi-structured interview questions developed, workshops on the analytical framework for data analysis conducted, and a report writing process established. A framework for data analysis for the interviews within a case was created and this led to cross-case analysis. From each interview the key themes were drawn out using the interview transcripts, OSH and ACC information. When two cases were completed a formal stocktake was done to determine whether the process was working correctly. Once all the interviews had been conducted the themes from all cases were then analysed and cross-case analysis performed.
Fifteen cases were selected using a number of criteria including age, family status, socio-economic status, occupation, gender, nature of workplace injury or illness or conditions/environment. All but one of the cases had been the subject of an OSH investigation and were, in the opinion of the inspector involved, characterised by causing serious direct consequences to the participants. As such, they should not be seen as ‘average’, but were selected to represent what happens when things go seriously wrong. Therefore, while the cases were representative of ordinary people in common industries, they also represented the potential for serious consequences when things go wrong.
The research team was made up of seven researchers from the Department of Labour, two independent researchers, and a researcher from ACC. The team was from a wide range of academic disciplines and backgrounds (nursing, law, community development, and social sciences). An external virtual group was set up to provide extra input by electronic mail. Information and comments were available to the whole group. It helped to keep those outside the project up to date with the research, provided different perspectives, gave additional information and access to international knowledge.
We attempted to measure economic costs. We divided economic costs into two types:
• unknown economic costs – costs which are known to exist but for which dollar values were not known.
• known economic costs – specific dollar costs.
Costs were viewed in terms of which person or organisation bore them. These costs were worked out from both documented and secondary sources.
Social consequences were not given a dollar value, but we sought a detailed understanding from participants, families and workplaces and others in the interviews.
The research produced seven principle findings from analysis of the case studies:
1. Minor mistakes cause big consequences
Workplace injury or illness often resulted from minor failures in workplace systems or practices. Gaps in systems or practices that may have seemed minuscule or insignificant prior to an injury or illness often turned out to have huge consequences for the affected person and others.
2. The consequences ripple out
Injury or illness had huge consequences not just for the participant but for their family, their workplace and their community. The effects rippled out from the participant to touch the whole community.
3. Costs were enormous, non-recoverable and ongoing
The social and economic costs of a workplace injury or illness are non-recoverable and ongoing. They include both quantifiable and unquantifiable costs, and they continue to mount long after the injury or illness event.
4. In spite of common characteristics between cases, consequences varied greatly
Although there were commonalties between the cases in the study, each injury or illness there were also unique individual or situational factors. Other influences to be considered were personal, social, organisational and environmental variables. These all affected the consequences of the injury or illness.
5. Relationship between cause and consequence
This research indicated that if a company has good health and safety systems that were an integral part of the work environment, then their support systems for injured or ill employees were also better. A full commitment to health and safety by an employer was more often than not reflected in rehabilitation and support structures. There was in effect, a health and safety culture.
6. Over-arching cost determinants
A number of over-arching cost determinants emerged from analysis of the data. These determinants included isolation, suffering, responsibility, blame, power and understanding. The cost determinants were most often linked and inter-dependent and influenced the recovery and coping ability of the affected.
Support, in whatever form, and whether from family, friends, colleagues, workplace and/or community, was again a major factor in the recovery and the ability of the injured or ill person to cope, as well as for others affected. Better support resulted in better rehabilitation outcomes and an easier return to working and community life.