Shiftwork and Fatigue: Understanding the Human Machine
Transcript of Shiftwork and Fatigue: Understanding the Human Machine
Shiftwork and Fatigue:Understanding the Human Machine
Andrew Moore-EdeDirector of Client Services
© 2017 Circadian International, Inc
HUMAN DESIGN SPECSThe Biological Clock (SCN) & Circadian Rhythms
Spinal Cord
Hypothalamus Cortex
Brain StemPituitary
Optic NerveEye
SCN
• Virtually every function in the body follows a predictable Circadian (daily) rhythm that is controlled by our Biological Clock (SCN)
• Hormone Secretions, Digestion, Body Temperature• Sleep and Alertness levels
• Disrupted circadian rhythms create health, safety and performance challenges for shiftworkers
© 2017 Circadian International, Inc
HUMAN DESIGN SPECS: Circadian Rhythm of Alertness
20
15
5
0
12 15 18 21 24 03 06 09 12
10
Aler
tnes
s Le
vel (
MSL
T)
Time of Day
Most Olympic Track & Field Records Set
Fifteen-fold Increase In Industrial Accidents
Dangerously Drowsy
Full Alertness
Reduced Alertness
Drowsy
Moderate Alertness
© 2017 Circadian International, Inc
HUMAN DESIGN SPECS:Productivity by Time of Day
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-2.5
-2
-1.5
-1
-0.5
0
0.5
1
1.5
Noon2 P
M4 P
M6 P
M8 P
M10
PM
Midnigh
t2 A
M4 A
M6 A
M8 A
M10
AM
Time of Day
Rela
tive
Effic
ienc
y
Productivity decreases at night by 5-10%
Source: Folkard S and Tucker P. “Shift work, safety and productivity” Occupational Medicine 2003;53:95-101.
What are the Costs and Risks of Shiftwork?
© 2017 Circadian International, Inc 6
OVERALL COSTS OF SHIFTWORK
Extended hours operations cost U.S. businesses over $200 billion annually (~$11,000 per employee)
© 2017 Circadian International, Inc
COSTS OF SHIFTWORK:Absenteeism
Five times higher for extended hours employees (12.4% vs. 2.4%)
Major reasons cited for Absenteeism:
Balancing work/family life
Reduced sleep (i.e. fatigue)
Higher incidence of sickness/health issues
© 2017 Circadian International, Inc
COSTS OF SHIFTWORK:Turnover
Shiftworkers average: 9.8% per year, vs. 3.4% overall
Turnover of new hires in double digits
Average cost of replacing an extended hours employee: $30,115
Turnover costs $2,255 per extended hours employee per year, compared to $624 per day worker
© 2017 Circadian International, Inc
COSTS OF SHIFTWORK:Health Care Costs
Shiftworkers exhibit higher rates of certain health issues:
18
Obstructive Sleep Apnea 300%-400% higher
Gastrointestinal Disorders 200%-300% higher
Cardiovascular Disease 200%-300% higher
Musculoskeletal Problems 150%-200% higher
Health and Wellness Costs 200%-300% higher
© 2017 Circadian International, Inc 10 Source: CIRCADIAN, Financial Opportunities in Extended Hours Operations
COSTS OF SHIFTWORK:Average Cost of an Accident/Injury: Day vs. Night
Average Night Cost = $10,200 Average Day Cost = $6,200
Increased cost of nightshift accidents based on insurance company claims data
Avg. Night
Avg. Day
© 2017 Circadian International, Inc
COSTS OF SHIFTWORK:Productivity
Fatigue Causes: Reduced reactions times
& coordination Miscommunication /
misunderstanding Decreased motivation
(burnout) Impaired decision
making (risk-taking)…Which Leads To: Inappropriate/slow response Low morale Increased human error/procedural
deviations
Productivity decreases at night by 5-10%
-2.5
-2
-1.5
-1
-0.5
0
0.5
1
1.5
Noon2 P
M4 P
M6 P
M8 P
M10
PM
Midnigh
t2 A
M4 A
M6 A
M8 A
M10
AM
Time of Day
Rela
tive
Effic
ienc
y
Fatigue Risk Management Systems
The optimal way to manage and reduce employee fatigue risk and improve productivity
© 2017 Circadian International, Inc 1313
FATIGUE RISK MANAGEMENT SYSTEMSEmergence as Global Standard for 24/7 Operations
1890 Commercialization of electric light
1908-1999 Hours of Service regulations attempt fatigue control by limiting the number of hours of work per day, per week and/or per month
1970-1990 Advances in circadian sleep science show fatigue inadequately controlled by limiting work-rest hours – “compliant but unsafe”
1990-2005 Early development of comprehensive fatigue risk management systems (FRMS)
2005-2017 Widespread international adoption and introduction of regulations & standards requiring FRMS
© 2017 Circadian International, Inc 14
Goa
ls
Act
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M
etri
cs
Inci
dent
s&
Acc
iden
ts
Fatigue-related Errors
Sufficient Staffing Levels
Defense 1Sufficient Sleep Opportunity
Shift / Duty scheduling, Overtime policies, Fatigue risk models
Sufficient Sleep Obtained
Employee training Sleep disorder treatment & compliance
Sufficient Workplace Environment
Sufficient Alertness Behavior
Peer monitoring Fitness for duty audit, Fatigue monitoring
Schedule Driven Fatigue Risk
Sleep Deprivation Lifestyle stress
Workplace Environment Fatigue
Excessive overtime Staffing Imbalance
Workload-Staffing BalanceProportional 24/7 staffing
Workplace design,
Regulating Blue Light
SLEEP ALERTNESS
Defense 2 Defense 3 Defense 4 Defense 5
Fatigue Risk Root Cause Analysis
Fatigue Risk Management System: 5 Defenses & Feedback Loop
© 2017 Circadian International, Inc 15
Goa
ls
Act
ions
M
etri
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Sufficient Staffing Levels
Defense 1
Excessive overtime Staffing Imbalance
Workload-Staffing BalancingProportional 24/7 staffing
SLEEP ALERTNESS
Defense 2 Defense 3 Defense 4 Defense 5
FRMS DEFENSES IN DEPTH#1. STAFF-WORKLOAD BALANCE
CAUSES OF INADEQUATE STAFFING• Increasing production but not automation or employees• Creep from 5 to 6 to 7 day operations with 3 crews• Workload fluctuates across 168 hour week but shifts
are equally staffed• Employees addicted to overtime, management likes
low headcount, cautious about hiring
SYMPTOMS OF INADEQUATE STAFFING• Excessive average overtime • Increased absenteeism rates• Unplanned open shifts• Increase in fatigue-related errors/incidents• Burn-out, high stress levels
© 2017 Circadian International, Inc 16
HOURS PER WEEK AND INJURY RATE
0
1
2
3
4
5
6
7
8
9
10
<40 40-44.9 45-49.9 50-54.9 55-59.9 60-64.9 >65
Hours/week
Inci
denc
e ra
te p
er 1
00 w
orke
r-ye
ars
Source: Dembe et al. 2005 (Occup Environ Med), based on 89,729 person years of work
Working 60+ hours per week (e.g., 5 x 12-hr shifts) was associated with a 23% increased hazard rate
© 2017 Circadian International, Inc 17
Histogram of Fatigue Index - mean: 40.58 std_dev: 20.44 std_err: 0.69
Fatigue Index10095908580757065605550454035302520151050
Freq
uenc
y in
Per
cent
4
3
2
1
0
(n=868)
Probability of DO
T-Recordable Accidents
0
0.1
0.2
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0.4
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0.6
DEFENSE TOOL - CAS FATIGUE MODEL VALIDATION Employee CAS Fatigue Score vs. Accident Rate
LowFatigue
HighFatigue
AverageFatigue
HIGHRISK
EMPLOYEES
Time of Day00222018161412100806040200222018161412100806040200
Dat
e
8/24/20028/22/20028/20/20028/18/20028/16/20028/14/20028/12/20028/10/2002
8/8/20028/6/20028/4/20028/2/2002
7/31/20027/29/20027/27/20027/25/20027/23/2002
BEST PREDICTOR OF HUMAN ERROR RISK IS CAS FATIGUE SCORE CALCULATED FROMPREVIOUS 7-14 DAYS WORK-REST PATTERN
© 2017 Circadian International, Inc 18
FATIGUE RISK FACTORS
• Duration of shift • Number of consecutive working days• Time off between shifts• Time off between blocks of consecutive shifts
OTHER CIRCADIAN FACTORS
• Fixed versus rotating• Speed of rotation• Direction of rotation• Start/end times of shifts• Regularity/Irregularity of shift times
Goa
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Act
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M
etri
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Sufficient Staffing Levels
Defense 1Sufficient Sleep Opportunity
Shift / Duty scheduling, Overtime policies, Fatigue risk models
Schedule Driven Fatigue Risk
Excessive overtime Staffing Imbalance
Workload-Staffing BalanceProportional 24/7 staffing
SLEEP
Defense 2
FRMS DEFENSES IN DEPTH#2. SHIFT SCHEDULING
© 2017 Circadian International, Inc 19
WHAT’S THE BEST SHIFT SCHEDULE?
Unlimited number of schedules for a 7-day operationMON TUE WED THU FRI SAT SUN
1 D D D D D - -
2 E E E E E - -
3 N N N N N - D
4 D D D D - - E
5 E E E E - - N
6 N N N N - D D
7 D D D - - E E
8 E E E - - N N
9 N N N - D D D
10 D D - - E E E
11 E E - - N N N
12 N N - D D D D
13 D - - E E E E
14 E - - N N N N
15 N - D D D D D
16 - - E E E E E
17 - - N N N N N
18 - D D D D D -
19 - E E E E E -
20 - N N N N N -
MON TUE WED THU FRI SAT SUN
1 D D D D D D D
2 - - E E E E E
3 E E - - N N N
4 N N N N - - -
7 - 2, 7 - 2, 7 - 3
MON TUE WED THU FRI SAT SUN
1 D D D D D D D
2 - E E E E E E
3 E - N N N N N
4 N N - - - - -
7 - 1, 7 - 1, 7 - 5
Day Shift
CREW WEEK MON TUE WED THU FRI SAT SUN1 D D D D D D D
A 2 - - D D D D D
Crew 3 D D - - D D D
4 D D D D - - -
Evening Shift
CREW WEEK MON TUE WED THU FRI SAT SUN1 - - E E E E E
B 2 E E - - E E E
Crew 3 E E E E - - -
4 E E E E E E E
Night Shift
CREW WEEK MON TUE WED THU FRI SAT SUN1 N N - - N N N
C 2 N N N N - - -
Crew 3 N N N N N N N
4 - - N N N N N
Swing Shift
CREW WEEK MON TUE WED THU FRI SAT SUN1 E E N N - - -
D 2 D D E E N N N
Crew 3 - - D D E E E
4 N N - - D D D
7-2,7-2,7-3
MON TUE WED THU FRI SAT SUN
1 D D - - N N N
2 - - D D - - -
3 N N - - D D D
4 - - N N - - -
2-2, 3-2, 2-3
© 2017 Circadian International, Inc
OperatingParameters
SHIFT SCHEDULE DESIGN CONSIDERATIONSBest Schedule is Site Specific
Health andSafety
Parameters
EmployeeParameters
Criteria
A
BC
Involve employees in the process
Transfers ownership of the new schedule to the employees
Ensures best schedule is achieved
Avoids costly distractions/disruptions (and sometimes permanent damage) that accompanies many scheduling changes
Will improve employee health, safety, and quality of life
Will improve operational efficiency
© 2017 Circadian International, Inc 21
• CAUSES OF INADEQUATE SLEEP DURATION & QUALITY Giving sleep a low priorityPoor sleep planningBedroom not suited for day sleepLack of family awareness/supportUndiagnosed/untreated sleep disorders
• SYMPTOMS OF INADEQUATE SLEEP DURATION & QUALITYChronic sleepiness & fatigueSleep episodes on the jobMicrosleeps on the highwaySnoring, multiple wakings, apneasFatigue-related errors/incidents
Goa
ls
Act
ions
M
etri
cs
Sufficient Staffing Levels
Defense 1Sufficient Sleep Opportunity
Shift / Duty scheduling, Overtime policies, Fatigue risk models
Sufficient Sleep Obtained
Employee training Sleep disorder treatment & compliance
Schedule Driven Fatigue Risk
Sleep Deprivation Lifestyle stress
Excessive overtime Staffing Imbalance
Workload-Staffing BalanceProportional 24/7 staffing
SLEEP
Defense 2 Defense 3
FRMS DEFENSES IN DEPTH#3: FATIGUE TRAINING & SLEEP DISORDERS
© 2017 Circadian International, Inc 22
DEFENSE # 3: COMMUNICATION, EDUCATION & TRAINING
Training On Managing Fatigue and a Shiftwork Lifestyle Should Cover:
Human Design Specs Getting Better Sleep Staying Safe and Alert Nutrition & Health Family & Social Life
Multiple delivery modes Classroom training (“Managing a Shiftwork Lifestyle”) Train-the-Trainer – building internal competence Fatigue Training Online – with testing & certification Newsletters, booklets, video
© 2017 Circadian International, Inc
BENEFITS OF FATIGUE TRAININGImproved Sleep Duration
Average duration of daytime sleep obtained (when working night shift) prior to and after shiftwork lifestyle training.
4.85.8
01234567
Before Training After Training
Ho
urs
of
Day
tim
e S
leep
Source: Dawson 2009
© 2017 Circadian International, Inc 24
Goa
ls
Act
ions
M
etri
cs
Sufficient Staffing Levels
Defense 1Sufficient Sleep Opportunity
Shift / Duty scheduling, Overtime policies, Fatigue risk models
Sufficient Sleep Obtained
Employee training Sleep disorder treatment & compliance
Sufficient Workplace Environment
Schedule Driven Fatigue Risk
Sleep Deprivation Lifestyle stress
Job Task & Workplace Environment Fatigue
Excessive overtime Staffing Imbalance
Workload-Staffing BalanceProportional 24/7 staffing
Workplace design,
Regulating Blue Light
SLEEP ALERTNESS
Defense 2 Defense 3 Defense 4 Defense 5
FRMS DEFENSES IN DEPTH#4: JOB & WORKPLACE DESIGN
© 2017 Circadian International, Inc 25
DEFENSE 4: WORKPLACE ENVIRONMENT
KEY DETERMINANTS OF SAFETY & PERFORMANCE
Light Temperature Humidity Sound Level Sound Pattern Aroma
© 2017 Circadian International, Inc
Growing Awareness of the Health Risk of Light at Night
The primary human concern with nighttime lighting include… potential carcinogenic effects related to melatonin suppression, especially breast cancer.
Other diseases that may be exacerbated by circadian disruption include:
• Obesity• Diabetes• Depression• Mood Disorders• Reproductive problems
“Epidemiological studies have found that long-term night-workers have a higher risk of breast cancer risk than women who do not work at night.
These studies have involved mainly nurses and flight attendants. The studies are consistent with animal studies that demonstrate that constant light, dim light at night, or simulated Chronic jet lag can substantially increase tumor development.
Other experimental studies show that reducing melatonin levels at night increases the incidence or growth of tumors.”
Shiftwork that involves circadian disruption is “probably carcinogenic to humans”
2007 2012
Exposures to artificial light at night (ALAN) or changes in the timing of exposures to natural light (such as with ‘jet lag’) may disrupt biological processes controlled by endogenous circadian rhythms, potentially resulting in adverse health outcomes. NTP is interested in understanding the health effects of circadian disruption related to ALAN and shift work. NTP’s Office of the Report on Carcinogens (ORoC) and Office of Health Assessment and Translation (OHAT) plan to conduct health hazard assessments focusing on cancer (ORoC) and non-cancer health outcomes (OHAT).
NIH Workshop: Shift Work at Night, Artificial Light at Night, and Circadian Disruption
2016
© 2017 CIRCADIAN Proprietary
© 2017 Circadian International, Inc
2001 Discovery: Circadian Clock (SCN) uses blue wavelengths to track day and night*
SCNCircadian Clock
Bio-Active Blue Light
Thousands of Years
100 Years
*Brainard GC, et al. The Journal of Neuroscience 2001.
© 2017 Circadian International, Inc
Risks of Light at Night Increased by Blue-Rich Energy-Efficient Lighting
Improved Energy Efficiency
Extended Lifetime (Reduced Replacement & Labor Costs)
AND Increased Bio-Active Blue Exposure Risk
Lumensper Watt
LED Lighting provides: INCANDESCENT FLOURESCENT LED
© 2017 CIRCADIAN Proprietary
© 2017 Circadian International, Inc
It’s Not “Good Blue” vs. “Bad Blue”… It’s Time of Day
Daytime Electric Light Nocturnal Electric Light
Day Benefits• Increased Alertness• Increased Vigilance• Increased Productivity• Sleep Improvement• Mood Improvement• Health Improvement
Night Costs• Sleep Disruption• Breast/prostate/colon cancers• Obesity/diabetes Type 2
metabolic syndrome• Cardiovascular disease• Depression/mood disorder
Blue Blue
© 2017 CIRCADIAN Proprietary
© 2017 Circadian International, Inc
QUESTION:
If blue light exposure at night disrupts circadian rhythms,
what’s the best light solution for shiftwork operations?
© 2017 Circadian International, Inc
CIRCADIAN Light Center: Human Subject Medical Studies
• Controlled for: Daytime Light Exposure, Work Schedule, Illumination (Lux), Diet and Environment
• Simulation: 24/7 day and night work shifts Full length 12-hour shifts
• Sleep Lab facility including EEG• Blood tests (lipids, cardiac markers)• Glucose Tolerance tests (Diabetes)• 24 hour urine melatonin collection• Salivary Melatonin 30 minute intervals• Blood pressure• Alertness & performance tests• Mood and Depression scale test• Human Subject testing under IRB approval
LED product development guided and optimized by medical research
Multiple SPDs of polychromatic white light tested for 24/7 human effectiveness
© 2017 Circadian International, Inc
Conventional Blue-Pump LED
Wavelength (nm)400 500 600 700
Rad
iant
Flu
x ( µ
W/n
m)
0
10000
20000
30000
40000
50000
CIRCADIAN® Night LED
Wavelength (nm)400 500 600 700
Rad
iant
Flu
x ( µ
W/n
m)
0
10000
20000
30000
40000
50000
60000
Bio-Active BlueBio-Active Blue
LM-79 Fixture Data
2%20% 3100K
CIRCADIAN® Day LED
3900K
Developing Day and Night LED Chips to Control Blue Light
© 2017 Circadian International, Inc
Is there a solution? Bright White Energy-Efficient LED Light 24/7with Low Blue Night and High Blue Day
NIGHT DAY NIGHT
High Quality White Light 24/7
% Bio-Active Blue
LOW
HIGH
Timing the Dosing of Bio-Active Blue Light
CIRCADIAN® Autonomous Control Board
CIRCADIAN® Light Engine with Day & Night LED Chips
© 2017 Circadian International, Inc
Blue-Depleted White Light Restores Melatonin at Night
Mel
aton
in (p
g/m
l)
Time of Day
Conventional Blue Pump LED
© 2017 CIRCADIAN Proprietary
© 2017 Circadian International, Inc
Wait a Minute!Wouldn’t Restoring Melatonin Make Night Shift Workers Sleepy?
One of the greatest myths in sleep physiology is that:
“Melatonin is the Sleep Hormone”
In fact…
• Nocturnal animals are most active when melatonin peaks at night
• Infusions of physiological levels of melatonin do not induce sleep Only high pharmacological doses of melatonin are sophorific
• No correlation between the percent suppression of melatonin by light at night and percent change in sleepiness
• Alertness can be increased by blue-depleted light which restores melatonin
Melatonin is really the darkness hormone and not the sleep hormone
© 2017 Circadian International, Inc 36
Goa
ls
Act
ions
M
etri
cs Fatigue-
related Errors
Sufficient Staffing Levels
Defense 1Sufficient Sleep Opportunity
Shift / Duty scheduling, Overtime policies, Fatigue risk models
Sufficient Sleep Obtained
Employee training Sleep disorder treatment & compliance
Sufficient Workplace Environment
Sufficient Alertness Behavior
Peer monitoring Fitness for duty audit, Fatigue monitoring
Schedule Driven Fatigue Risk
Sleep Deprivation Lifestyle stress
Workplace Environment Fatigue
Excessive overtime Staffing Imbalance
Workload-Staffing BalanceProportional 24/7 staffing
Job stimulationWorkplace design, Light color filtering,
SLEEP ALERTNESS
Defense 2 Defense 3 Defense 4 Defense 5
FRMS DEFENSES IN DEPTH#5: FATIGUE MONITORING
© 2017 Circadian International, Inc 37
Goa
ls
Act
ions
M
etri
cs
Inci
dent
s&
Acc
iden
ts
Fatigue-related Errors
Sufficient Staffing Levels
Defense 1Sufficient Sleep Opportunity
Shift / Duty scheduling, Overtime policies, Fatigue risk models
Sufficient Sleep Obtained
Employee training Sleep disorder treatment & compliance
Sufficient Workplace Environment
Sufficient Alertness Behavior
Peer monitoring Fitness for duty audit, Fatigue monitoring
Schedule Driven Fatigue Risk
Sleep Deprivation Lifestyle stress
Workplace Environment Fatigue
Excessive overtime Staffing Imbalance
Workload-Staffing BalanceProportional 24/7 staffing
Job stimulationWorkplace design, Light color filtering,
SLEEP ALERTNESS
Defense 2 Defense 3 Defense 4 Defense 5
Fatigue Risk Root Cause Analysis
FRMS DEFENSES IN DEPTH#6 ROOT CAUSE ANALYSIS & FEEDBACK
© 2017 Circadian International, Inc
FACTS™: Web-Based and Easy-to-Use(facts.circadian.com)
© 2017 Circadian International, Inc
1) Fatigue RiskMitigation:
Policies, Practices & Technology
3) Fatigue RiskData Collection
and Analysis
2) Fatigue RiskManagement
Communication &Training
4) Fatigue RiskManagement
ProgramEvaluation
Develop a written
Fatigue Risk Management
Plan
Senior Management:
makes acommitment to
reducing fatigue in operation
Project Team: Conduct gap
analysis to identify existing fatigue
programs and gaps in
defense
Developing a Fatigue Risk Management Plan
ControllingFatigueHazards
Continuous Improvement
OBJECTIVES
© 2017 Circadian International, Inc
1. Fatigue is inherent in all shiftwork operations
2. Costs, risks and liabilities of fatigue are substantial ($11,000 USD per shiftwork employee)
3. FRMS are the optimal way to manage and reduce employee fatigue risk and improve productivity
4. Take Action: Create a FRMS Plan, Strengthen Defenses (staffing, scheduling, training, environment, policies, etc.)
CONCLUSIONS