Developing Best-Practice Guidelines for Improving Bus Operator Health and Retention (2014)

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T R A N S I T C O O P E R A T I V E R E S E A R C H P R O G R A M TCRP REPORT 169 TRANSPORTAT ION RESEARCH BOARD WASHINGTON, D.C. 2014 www.TRB.org Research sponsored by the Federal Transit Administration in cooperation with the Transit Development Corporation Developing Best-Practice Guidelines for Improving Bus Operator Health and Retention Robin Mary Gillespie Xinge Wang Tia Brown TransporTaTion Learning CenTer Silver Spring, MD Subject Areas Public Transportation

TCRP REPORT 169 Project F-17 ISSN 1073-4872 ISBN 978-0-309-28424-0 © 2014 National Academy of Sciences. All rights reserved. COPYRIGHT INFORMATION Authors herein are responsible for the authenticity of their materials and for obtaining written permissions from publishers or persons who own the copyright to any previously published or copyrighted material used herein. Cooperative Research Programs (CRP) grants permission to reproduce material in this publication for classroom and not-for-profit purposes. Permission is given with the understanding that none of the material will be used to imply TRB, AASHTO, FAA, FHWA, FMCSA, FTA, or Transit Development Corporation endorsement of a particular product, method, or practice. It is expected that those reproducing the material in this document for educational and not-for-profit uses will give appropriate acknowledgment of the source of any reprinted or reproduced material. For other uses of the material, request permission from CRP. NOTICE The project that is the subject of this report was a part of the Transit Cooperative Research Program, conducted by the Transportation Research Board with the approval of the Governing Board of the National Research Council. The members of the technical panel selected to monitor this project and to review this report were chosen for their special competencies and with regard for appropriate balance. The report was reviewed by the technical panel and accepted for publication according to procedures established and overseen by the Transportation Research Board and approved by the Governing Board of the National Research Council. The opinions and conclusions expressed or implied in this report are those of the researchers who performed the research and are not necessarily those of the Transportation Research Board, the National Research Council, or the program sponsors. The Transportation Research Board of the National Academies, the National Research Council, and the sponsors of the Transit Cooperative Research Program do not endorse products or manufacturers. Trade or manufacturers’ names appear herein solely because they are considered essential to the object of the report. TRANSIT COOPERATIVE RESEARCH PROGRAM The nation’s growth and the need to meet mobility, environmental, and energy objectives place demands on public transit systems. Current systems, some of which are old and in need of upgrading, must expand service area, increase service frequency, and improve efficiency to serve these demands. Research is necessary to solve operating problems, to adapt appropriate new technologies from other industries, and to intro- duce innovations into the transit industry. The Transit Cooperative Research Program (TCRP) serves as one of the principal means by which the transit industry can develop innovative near-term solutions to meet demands placed on it. The need for TCRP was originally identified in TRB Special Report 213—Research for Public Transit: New Directions, published in 1987 and based on a study sponsored by the Urban Mass Transportation Administration—now the Federal Transit Admin istration (FTA). A report by the American Public Transportation Association (APTA), Transportation 2000, also recognized the need for local, problem- solving research. TCRP, modeled after the longstanding and success- ful National Cooperative Highway Research Program, undertakes research and other technical activities in response to the needs of tran- sit service providers. The scope of TCRP includes a variety of transit research fields including planning, service configuration, equipment, facilities, operations, human resources, maintenance, policy, and administrative practices. TCRP was established under FTA sponsorship in July 1992. Pro- posed by the U.S. Department of Transportation, TCRP was autho- rized as part of the Intermodal Surface Transportation Efficiency Act of 1991 (ISTEA). On May 13, 1992, a memorandum agreement out- lining TCRP operating procedures was executed by the three cooper- ating organizations: FTA, the National Academies, acting through the Transportation Research Board (TRB); and the Transit Development Corporation, Inc. (TDC), a nonprofit educational and research orga- nization established by APTA. TDC is responsible for forming the independent governing board, designated as the TCRP Oversight and Project Selection (TOPS) Committee. Research problem statements for TCRP are solicited periodically but may be submitted to TRB by anyone at any time. It is the responsibility of the TOPS Committee to formulate the research program by identi- fying the highest priority projects. As part of the evaluation, the TOPS Committee defines funding levels and expected products. Once selected, each project is assigned to an expert panel, appointed by the Transportation Research Board. The panels prepare project state- ments (requests for proposals), select contractors, and provide techni- cal guidance and counsel throughout the life of the project. The process for developing research problem statements and selecting research agencies has been used by TRB in managing cooperative research pro- grams since 1962. As in other TRB activ ities, TCRP project panels serve voluntarily without com pensation. Because research cannot have the desired impact if products fail to reach the intended audience, special emphasis is placed on dissemi- nating TCRP results to the intended end users of the research: tran- sit agencies, service providers, and suppliers. TRB provides a series of research reports, syntheses of transit practice, and other support- ing material developed by TCRP research. APTA will arrange for workshops, training aids, field visits, and other activities to ensure that results are implemented by urban and rural transit industry practitioners. The TCRP provides a forum where transit agencies can cooperatively address common operational problems. The TCRP results support and complement other ongoing transit research and training programs. Published reports of the TRANSIT COOPERATIVE RESEARCH PROGRAM are available from: Transportation Research Board Business Office 500 Fifth Street, NW Washington, DC 20001 and can be ordered through the Internet at http://www.national-academies.org/trb/bookstore Printed in the United States of America

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. The Transportation Research Board is one of six major divisions of the National Research Council. The mission of the Transporta- tion Research Board is to provide leadership in transportation innovation and progress through research and information exchange, conducted within a setting that is objective, interdisciplinary, and multimodal. The Board’s varied activities annually engage about 7,000 engineers, scientists, and other transportation researchers and practitioners from the public and private sectors and academia, all of whom contribute their expertise in the public interest. The program is supported by state transportation departments, federal agencies including the component administrations of the U.S. Department of Transportation, and other organizations and individu- als interested in the development of transportation. www.TRB.org www.national-academies.org

C O O P E R A T I V E R E S E A R C H P R O G R A M S AUTHOR ACKNOWLEDGMENTS Robin Mary Gillespie, PhD, MPH, Senior Program Director for Health and Safety, Transportation Learning Center, was the Project Director and Principal Investigator. The other authors of this report are Xinge Wang, MS, Director of Research, Transportation Learning Center, and Tia Brown, MPM, MIS Project Associate, Transportation Learning Center. The research team included June Fisher, MD, Trauma Foundation, San Francisco; Deborah McLellan, PhD, Research Scientist, CCBR, Dana-Farber Cancer Institute; Paul Landsbergis, PhD, EdD, MPH, Associate Professor, Department of Environmental and Occupational Health Sciences, School of Public Health, SUNY Downstate Medical Center; and Charles Levenstein, PhD MSc, Professor Emeritus of Work Environment, University of Massachusetts Lowell. Research assistance was provided by George Koutsouras, MPH, Department of Environmental and Occupational Health Sciences, School of Public Health, SUNY Downstate Medical Center. CRP STAFF FOR TCRP REPORT 169 Christopher W. Jenks, Director, Cooperative Research Programs Gwen Chisholm-Smith, Senior Program Officer Jeffrey Oser, Senior Program Assistant Eileen P. Delaney, Director of Publications Scott E. Hitchcock, Editor TCRP PROJECT F-17 PANEL Field of Human Resources Michael Ford, Ann Arbor Transportation Authority, Ann Arbor, MI (Chair) Michael Glikin, Metropolitan Transportation Authority–New York City Transit, Brooklyn, NY Karen Heaton, University of Alabama, Birmingham, Birmingham, AL Daria Luisi, Consolidated Edison Company of New York, Inc., New York, NY Daisy Mara, Dallas Area Rapid Transit, Dallas, TX Donna K. Simmons, Capital Metropolitan Transportation Authority, Austin, TX Ed Watt, Amalgamated Transit Union, Washington, DC Victor Bernard Wiley, Florida DOT, Tallahassee, FL Jarrett W. Stoltzfus, FTA Liaison Jan Birdsey, Centers for Disease Control and Prevention Liaison Richard Pain, TRB Liaison

F O R E W O R D By Gwen Chisholm-Smith Staff Officer Transportation Research Board TCRP Report 169: Developing Best-Practice Guidelines for Improving Bus Operator Health and Retention addresses some of the health and safety issues common throughout the transit industry. TCRP Report 169 describes the approaches that transit organizations in the United States and Canada have taken to address the health problems faced by transit employ- ees, including identification of many common problems and detailed practices. The report includes a Practitioner’s Guide (Part I) and an Evaluation and Return on Investment (ROI) tem- plate titled, Transit Operator Workplace Health Protection and Promotion Planning, Evaluation, and Return on Investment (ROI) (available online) for use in implementing and carrying out transit-specific programs to protect the health of bus operators and other employees. The final research report (Part II) includes the background, research approach, literature review, case examples, and detailed case studies. The guide, template, and report are intended for use by senior managers, operations managers, organized labor, safety officials, medical per- sonnel, risk managers, human resources personnel, policymakers, and legal advisors. Transit bus operators work in a challenging environment that can lead to negative health outcomes for the operators and high costs for transit agencies due to health care costs, absenteeism, high levels of turnover, and workers’ compensation payments. Orga- nized labor leaders and transit managers agree that worker retention and career longevity are of paramount importance. In recent years, transit agencies and organized labor have created joint labor-management teams to identify and address operating issues related to operator health and stress in a number of locations. A number of transit agencies and organized labor have worked together in the United States and Canada to develop programs to reduce operator stress, improve operator health, and address health-related agency cost impacts. However, little attention has been given to substantive health and wellness program eval- uation. The results of this research may help to assess the broad array of health and wellness programs throughout United States and Canada, and provide assistance on how to evaluate the success of specific programs. The Transportation Learning Center prepared this report under TCRP Project F-17. The primary objective of this research was to develop best-practice guidelines and industry tools (including a cost and benefit template) to address some of the health and wellness issues common throughout the transit industry. To accomplish this objective, a comprehensive literature review was undertaken to identify applicable transit programs. In addition, a series of online surveys and interviews with transit agencies and union representatives were conducted to help establish a preliminary list of proven transportation practices related to health and wellness programs.

After gathering this information and conducting five detailed case studies, the research team worked to produce a catalogue of the common and innovative practices in transit Workplace Health Protection and Promotion. To provide transit systems of various sizes practical tools to address bus operator health, wellness, and retention, the researchers devel- oped a Practitioner’s Guide of best practices and tools, accompanied by a Return on Invest- ment template available on TRB.org by searching for “TCRP Report 169.”

C O N T E N T S P A R T I A Transit Workplace Health Protection and Promotion Practitioner’s Guide 1 Transit Operator Health: Introduction and Explanation 1 The Background 4 The Practitioner’s Guide 5 The Model 5 The Suggestions 6 The Practical Approach 9 Summary 10 The Practitioner’s Guide Map 11 Chapter Background 13 Chapter 1 Getting Started: Preparation and Commitment 14 Culture of Health and Safety 19 Organizational Needs Assessment 23 Organizational Resources 27 Meeting Needs with Resources 29 Summary 30 Tools + Resources 31 Chapter Background 33 Chapter 2 Building the Team: Coordinating Health Protection and Promotion 36 Taking the Lead 38 Putting the Team Together 41 Management Support 43 Labor Support 44 WHPP Committee 47 Champions and Ambassadors 48 Vendor Integration 50 Summary 52 Tools + Resources 52 Chapter Background 53 Chapter 3 Setting Targets: Effective Transit Health Protection and Promotion 56 Setting Priorities 59 A Comprehensive Health Risk Focus 63 Effective Components 66 Transit-Specific Programming 73 Summary 74 Tools + Resources 74 Chapter Background

75 Chapter 4 Implementing and Integrating: Balanced Workplace Health Protection and Promotion 78 An Inclusive Range 83 Transit-Specific Implementation 85 Effective Communications 87 Training Supports the Program 88 Equitable Incentives 90 Summary 91 Tools + Resources 91 Chapter Background 93 Chapter 5 Evaluating: Return on Investment and Ongoing Improvement 98 Evaluation Framework 100 Integrated Data Management 103 Process Measures 107 Impact and Outcome Measures 114 Cost-Benefit and Return on Investment 118 Data-Driven Ongoing Improvement 119 Summary 119 Tools + Resources 120 Cost-Benefit and ROI 122 Chapter Background 123 Chapter 6 Carrying On: Maintaining Effectiveness with Growth 124 Maintaining 126 Growing 128 A Realistic Perspective 129 Summary 130 Appendix A NIOSH Total Worker Health™ Elements 135 Appendix B Sleep Disturbance and Sleep Apnea for Transit Drivers P A R T I I Final Research Report 141 Summary 141 Transit Health Protection and Promotion Research 143 Important Targets for Transit Agencies 145 A Practical Application of WHPP Models 146 The Tools 146 Conclusion 148 Chapter 1 Introduction and Research Methods 148 Background 149 TCRP F-17: Defining Current and Best Practice for Bus Operator Health 149 Where the Transit Industry Stands 150 F-17 Project Products 150 Research Approach 150 Survey

151 Follow-up Data Collection and Case Examples 152 Case Studies 152 Defining Best Practices 153 Transit Workplace Health Protection and Promotion (WHPP) Practitioner’s Guide 153 Planning, Evaluation, and Return on Investment (ROI) Template 153 Subject-Matter Experts 154 Chapter 2 Literature Review 154 Literature Search 154 Transit Bus Operator Health 154 Prevalence of Health Problems Among Transit Workers 156 The Impact of Conditions of Work 156 Health Summary 157 Health Protection and Promotion Interventions 157 Effective Health Promotion 158 Research on Health Promotion in Transportation and Related Interventions 160 Other Programs Described 161 Literature Review Summary 162 The Workplace Health Protection and Promotion Model 162 International Perspective 162 US Workplace Health Protection and Promotion Suggestions 164 Chapter 3 Findings and Applications: A Profile of the Industry 164 Background 164 Program Characteristics 164 Demographics 165 Health, Wellness, and Safety Concerns 167 Workplace Health Promotion Programs 169 Program Structure and Responsibilities 169 WHPP Program Environment 171 What WHPP Models Are in Place in Transit Agencies? 171 How Did the Agency or Union Rate the Organization’s Health Culture and Organizational Strength? 173 How Competent Were Organizations? 174 How Did the Transit Agencies Rate Their Programs’ Impact? 175 WHPP and Workplace Policy 177 Chapter 4 Case Examples and Case Studies 177 Background 177 F-17 Case Example Catalog 177 Small Agency Examples 178 Medium Agency Examples 180 Large Agency Examples 182 Case Studies 182 Dallas Area Rapid Transit: A Case Study in Team Building 185 Edmonton Transit: A Case Study in Work-Related Health Protection 187 Orange County Transit Authority: A Case Study in Organizational Support 190 Capital Metropolitan Transportation Authority: A Case Study in Evaluation and Return on Investment

192 United Transportation Union—Los Angeles County Metropolitan Transportation Authority Wellness Program: A Case Study in Maintaining Effectiveness with Growth 195 Small Agency Programs: Characteristics and Challenges 196 Issues Facing Multi-Agency Programs 198 Chapter 5 From Industry Practice to Best Practice 198 Cataloging Effective Transit WHPP Practice 198 Reported WHPP Practices 200 Health Protection and Promotion Targets and Transit-Relevant Practices 200 Defining Effective Transit WHPP Practice 200 How Do Transit Agencies Compare to Recognized Standards of Effectiveness in WHPP? 206 A Model for Transit WHPP Practice 209 Chapter 6 Program Evaluation and Return on Investment 209 Background 209 Literature 210 Research Findings 210 Measures of Success 211 Return on Investment Calculations 211 Evaluation Practices by Agency Size 211 Issues and Suggestions 212 Lack of Resources 213 Silos Effect 213 Evaluation as an Afterthought 213 Data Confidentiality 213 Lack of Identifiable Savings in the Short Term 214 Difficulty Measuring Productivity 214 Impact on Retention 214 Difficulty Isolating Effects 214 Conclusion 215 Chapter 7 Toward a Transit-Specific Program 215 Answering the Initial Questions—A Summary of Transit Agency and Union Survey Responses 216 Research Highlights 216 Important Targets for Transit Agencies 217 A Practical Application of WHPP Models 218 The Tools 218 Transit Workplace Health Protection and Promotion (WHPP) Practitioner’s Guide 219 Planning, Evaluation, and Return on Investment (ROI) Template 219 Conclusion 220 References 224 List of Abbreviations A-1 Appendix A Roadmap and Best Practices for Transit Workplace Health Protection and Promotion B-1 Appendix B Supplementary Tables

C-1 Appendix C TCRP F-17: Improving Transit Bus Operator Health, Wellness, and Retention— Management Survey D-1 Appendix D TCRP F-17: Improving Transit Bus Operator Health, Wellness, and Retention—Labor Survey E-1 Appendix E F-17 Survey Follow-Up Data Collection Guidelines F-1 Appendix F Case Study Agency Snapshots G-1 Appendix G Transit Agency Materials and Reports H-1 Appendix H Sleep Disturbance and Sleep Apnea for Transit Drivers Note: Many of the photographs, figures, and tables in this report have been converted from color to grayscale for printing. The electronic version of the report (posted on the Web at www.trb.org) retains the color versions.