May 7, 2019
Absenteeism represents a significant cost to organizations, and sleep loss is one of its leading causes. Presenteeism, being at work but not working effectively, also leads to substantial reductions in productivity. With reduced physical and mental functioning due to lost sleep, productivity goes down.
Increased risk of errors
People with sleep deficits are not as productive as they could be, and they are also more prone to making mistakes and errors. An estimated 274,000 insomnia-related workplace accidents and errors occur yearly and cost U.S. employers more than $31 billion, which is more than any other chronic health-related condition.
Incidents and crashes
A 2014 study estimated that up to 21% of all fatal vehicle crashes might involve a drowsy driver. Factors that contribute to such events include working multiple jobs, working nights or other unusual schedules, getting less sleep than needed, and getting poor-quality sleep. Long commutes add to longer waking days and cut into the time available for sleep, putting many workers at increased risk for driving while drowsy.
ProTip: According to the NTSB: 20% of accidents are related to fatigue, with 40% of highway crashes involving fatigued drivers. Share this information as much as possible.
Fatigue culture is difficult to overcome
A workplace culture that rewards or tolerates fatigue can also be a factor. In some high-performance cultures, employees may view fatigue as a sign of weakness or laziness. They may be committed to getting the work done despite long hours, even coming to believe fatigue doesn’t affect them.
Employers may incentivize long hours with financial incentives or promotions, increasing risk, and promoting a culture of burnout instead of managing fatigue as a potential safety hazard.
Fatigue management as part of safety management systems
We address workplace fatigue through the same types of safety management mechanisms that an organization uses to for overall safety. Such an approach ideally applies multiple elements, recognizing that fatigue is a complex issue that can be minimized but not eliminated.
Getting started with a fatigue risk management system
Fatigue management is a way to further enhance the current safety management system and can rely on many existing mechanisms. As a first step, organizations should make an effort to understand what fatigue risks exist.
Incremental components or comprehensive plan
While a comprehensive fatigue management program may be the best approach, especially for larger organizations, test individual elements at first. A first part, perhaps smaller in scope, can be implemented and evaluated. Lessons learned can then be applied as the component is expanded upon and when considering other activities.
Form a fatigue committee
Designating an individual, or individuals, to head up fatigue management activities is critical for success. For larger organizations, a small committee can oversee activities, gather and evaluate feedback, and determine areas to focus efforts. Having representatives from across the organization such as safety, operations, and health/wellness will ensure that you include different perspectives.
It is essential that the fatigue management process be transparent and that appropriate information is shared throughout the effort to obtain buy-in from all levels of the organization. Providing open forums that allow employees to share how fatigue affects them is one way to get engagement from the outset.
Identifying fatigue risks
In addition to employee input, an audit or survey of supervisors and managers can help determine where fatigue risks exist and provide an indication of the magnitude. Such information can help prioritize what countermeasures or mitigation actions to take and where to focus efforts.
For the initial activities, it is imperative to present some action in the near term, so contributors will feel their input was and is incorporated. As a result, they are more likely to be engaged in the ongoing process and actions.
Critical components of a fatigue risk management system (FRMS)
Education and training
Sleep health education is a vital element of any fatigue management effort. Different delivery mechanisms can be considered and may be used over time as the program matures as a way to help keep information fresh. Depending on available resources, external expertise can be beneficial. In a public safety setting, expert-led sleep health training resulted in knowledge acquisition and subsequent actions to address sleep issues. Consider sleep health education as part of annual, recurrent, or new-hire training.
While individuals are generally unreliable at recognizing the effects of fatigue in themselves, developing a "personal signs and symptoms" checklist can provide a structured mechanism for self-assessment. People should include ways in which fatigue affects them, such as yawning or being forgetful and then track the number of hours of sleep in the past 24 hours, hours awake, and time of day. If multiple fatigue factors are present, then the individual should seek out countermeasures to boost alertness.Policies and practices
Clarify roles and expectations - A recognized internal point of contact with responsibility for fatigue management efforts is a necessary first step towards practical implementation. This individual should be responsible for managing communications about the program and coordinating all program activities. This “fatigue champion” recognizes both the benefit to the organization and employees’ lives. The champion can provide an extra level of motivation and inspiration that can lead to an exceptional fatigue management program.
Policies and practices for work periods - Effective policies and practices for hours of work and rest should be science-based and recognize the physiological need for sleep and circadian rhythms. They should also take into consideration the type of work that needs to be done and understand the characteristics of the workforce. There is no “one size fits all” number for daily or weekly work hours.
Daily and weekly limits - Daily fatigue risks increase with more hours on duty, or with more time on task (hours of work without a break). Daily work limits should also address the impact of hours awake, and how factors such as commute times and shift start times will affect the time workers are awake before the start of their work period.
Sleep loss throughout a workweek impairs performance. Setting weekly limits on total work hours and including a provision for a weekly off-duty “reset” period are common ways that organizations seek to manage the cumulative effects of sleep loss over time. The intent of the “reset” day or days off is to allow workers to obtain recovery sleep and be rested and ready for their next period of workdays.
Time-of-day fatigue (circadian rhythm misalignment) - Working at night and corresponding daytime sleep are both misaligned with the normal circadian rhythms. Fatigue risks increase during night shifts, and sleeping during the day is less than optimal due to the circadian clock. For those working a night shift, consider minimizing monotonous or monitoring tasks that can unmask underlying sleepiness, and safety-sensitive duties should be scheduled earlier in the work shift when possible.
ProTip: Early morning shifts require employees to adjust their sleep schedules, which might lead to chronic sleep loss. They also need employees to be alert when their bodies are still in sleep mode. Discuss this with your employees to raise awareness.
Limits on night shifts - With increased fatigue risks associated with working at night, employers should consider implementing shorter night shifts, which provides a way to minimize the interaction of risks related to hours awake and the increased likelihood of fatigue during the low point in circadian rhythms.
Fatigue risks have also been found to increase over consecutive night shifts, so minimizing multiple nights in a row and providing regular breaks should be considered.
Limits on early morning shifts - Early-morning shift starts can also infringe on individuals’ regular sleep periods. With long commutes, wake times necessary for early shift starts may feel more like the middle of the night than morning.
Difficulty in getting to bed earlier than our circadian clock’s programming is a challenge in getting adequate sleep.
Limits on work hours - While flexibility is necessary in many situations, additional restrictions should be considered for those working irregular schedules, for example limiting the number of on-call periods per week.
Shift workers are vulnerable to fatigue because of non-traditional work schedules that might require long shifts, non-daytime working hours, and changing shifts. As a result, shift workers are at a higher risk of drowsy driving.
One shift-working population that is at a particular risk is medical workers, who can log more than 100 hours in a workweek with very little sleep. After an extended shift, medical interns were five times more likely to have a near-miss incident on their commute home, and twice as likely to have a motor vehicle crash.
Fit for Duty - An employee arriving fit for duty is the responsibility of both the employer and the employee.
A workplace with positive environmental controls promotes better overall working conditions and should be less physically stressful in ways that contribute to fatigue on the job. Factors such as high temperatures, noise, and vibration are leading drivers of occupational fatigue.
Environmental factors can play a role in employees’ accumulation of fatigue. Things that help promote alertness include:
Also, designated break areas that are separate from the work areas can be an essential tool in managing fatigue. Break time in well-lit, moderate temperatures with adequate ventilation (fresh air) can provide an opportunity to reset for those working in physically stressful settings.
ProTip: Caffeine can provide a short-term boost to alertness when appropriately used. Rather than relying on caffeine throughout a shift, it is best to use it just before a critical work task or before the mid-afternoon period when sleepiness occurs. A cup of regular coffee with 100–200 mg of caffeine can boost alertness up to four hours, with about 15–30 minutes needed to take effect. Be cautious with sugar in coffee or caffeinated beverages, as it can reduce alertness when coming down from the “sugar high.”
Data-driven programs and continuous improvement
A fatigue management program provides the most value when it is data-driven and strives for constant improvement.
Ask employees for their input - Employees can be a wealth of information. You need to ask and listen.
Low reporting levels? Maybe something isn’t working. Don’t assume that low reporting levels mean there are no issues. Are reporting and monitoring systems effective? Usable? Are employees discouraged from reporting by the use of layered paperwork processes?
Monitoring and reporting mechanisms allow the program champion and other safety managers to assess the levels of fatigue risk in the organization over time, identify trends, and understand the issues that are being reported and need addressing. Incorporate reporting processes into current procedures within an existing safety management system. Keep in mind that when implementing a program, low levels of reporting may indicate a lack of awareness of the program rather than a lack of fatigue-related issues in the workplace.
Incident and accident investigation reporting
Established incident and accident investigation processes should be expanded to include an evaluation of the potential role of fatigue. Generally, a combination of factors present at the time of an incident/ accident would indicate that fatigue played a role. Include the following:
Review and learn from data
Incident and accident reports can be a valuable tool for the fatigue program manager. Look for trends in the types and sources of reported fatigue factors. Investigations can provide valuable “lessons learned” to incorporate into ongoing education and training activities.
Continuous improvement: collecting data and applying lessons learned
As with any organizational safety-related effort, it is essential to seek ways to continue improving operations. Monitoring and reporting information, along with incident or accident investigation and reporting, provides valuable information to the program manager.
Employers should consider a regular internal audit, or use of an external evaluator to address the above questions and determine ways for further improvements and expand the program.
Fatigue Management Tools
Scheduling software - Some industries, such as aviation, use programs that evaluate work schedules for potential fatigue risks as part of their fatigue management efforts. Such programs use science-based algorithms related to factors such as sleep need, circadian disruption, hours awake, and time of day. Safety managers then evaluate work schedules for potential issues and implement strategies that will attempt to address the problems and minimize risks.
Risk assessment tool - Factors include the length and timing of work periods, time-on-task, workload, consecutive days or nights of work, variations in work schedule, and timing and duration of rest periods.
Other factors to consider include worksite environmental conditions, commute times, and other potential stressors such as critical deadlines. Safety managers can similarly evaluate potential risks with this approach and determine interventions to minimize those risks.
ProTip: You can do all of this by using a tool like iReportSource by the way. So as I often ask folks; if you aren't already using a digital EHS solution, why?
Wrapping it all Up
The National Safety Council is leading the conversation on workplace fatigue in the U.S. Follow the various links in this post to learn more.
Cost of a Tired Workforce
NSC in collaboration with the Brigham and Women’s Hospital Sleep Matters Initiative developed an online fatigue cost calculator that estimates the cost of sleep deficiency for businesses. Entering four data points into the calculator – workforce size, industry, location, and shift scheduling practice – generates an estimated dollar cost that helps the organization quantify the cost of fatigue and justify the implementation of a fatigue risk management system (FRMS).
The cost calculator and the methodology used to create it are in Calculating the Cost of Poor Sleep: Methodology at www.nsc.org/tiredatwork.
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