Improving the Health and Safety of Transit Workers with Corresponding Impacts on the Bottom Line (2020)

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D-1 A P P E N D I X D Implementation Memo D.1 Overview TCRP Research Report 217 presents the results of TCRP Project F-26, “Improving the Health and Safety of Transit Workers with Corresponding Impacts on the Bottom Line.” The report explores the types of health and safety issues that are most likely to impact transit workers, beginning with a review of the available literature (Gillespie, Wang, and Brown 2014). The research used several existing data sources to understand the prevalence of common conditions and their costs to society and carried out five in-depth case studies of transit agency health and wellness programs. Based on the work in the report, the project team can suggest possible approaches to implementing a health and safety program at a transit agency and how to assess impacts on the bottom line. An immediate conclusion was that even the most well-designed programs will take time to set up properly and will need a steady source of funding. Also critical to any successful program is a process of evaluation—evaluation of programs is essential to understanding their effectiveness and improving their ability to serve the needs of transit workers. Incorporating evaluation elements into the program design from the beginning will lead to the best results. The literature review for this project explored issues linked to health and safety outcomes and costs as they relate to workforce conditions, as well as programs used to mitigate negative health and safety outcomes. The study reviewed, where possible, evidence of the cost-effectiveness of such programs and found that several factors faced by transit workers influence the health and safety of operators. These factors include, but are not limited to, the following: 1. Urinary tract problems that arise as a result of limited access to restrooms; 2. Musculoskeletal injuries resulting from prolonged sitting and repetitive motion; 3. Safety factors linked to actions by other drivers and unruly passengers; and 4. Access to food alternatives and fitness centers due to long, irregular, and split shifts. For non-operators, exposure to exhaust fumes and other automotive chemicals are also risk factors for poor health. The literature review further helped to document worker stress and fatigue as probable health and safety issues. The literature provides evidence of the direct costs of chronic health conditions, including absenteeism and turnover, and how wellness intervention programs function to mitigate these costs. There are relatively few studies that measure the indirect costs of occupational health injuries for transit workers, however, and limited data that provide evidence for the effectiveness of wellness intervention programs for the transit worker population. The literature is largely inconclusive on the effectiveness of wellness programs to reduce costs in general and specifically for transit agencies. Most programs are not well supported, funded, or targeted to the unique challenges transit workers face.

D-2 Improving the Health and Safety of Transit Workers with Corresponding Impacts on the Bottom Line D.2 Procedures The first step in deciding to implement a health and safety program is to identify the key issues that might affect the local workforce and identify existing sources of data related to the health and safety profiles of local transit workers. Any recent surveys or health insurance (claims) data are a good place to start. If there is no previous survey, claims data generally provide the best information about health issues. Accident records would be a good place to begin assessing whether sleep deprivation impacts transit workers. It is important to decide if the program will target only operators, or if maintenance staff will be included. Maintenance staff may face environmental issues (fumes, chemical exposures) but not the musculoskeletal and metabolic issues related to a sedentary job with limited access to restrooms, nutritious food, and irregular schedules. Agencies may want to consider a preventive program that encourages a “safety culture.” Agencies that focus on safety can get ahead of preventable accidents and other issues. This kind of program may be harder to implement because it will not show a large impact on the bottom line, but will rather be designed to prevent many problems, particularly maintenance and traffic accidents, from ever occurring. As part of the design process, agencies will need to assemble and seek support from management and labor. All the agencies we studied had a wellness committee with representation from labor and management. A planning committee is essential to implementing a program with the greatest reach. The planning committee should review the data and decide on a focus for the program. The potential program options should be shared with staff before a final decision is made about the program components, as gaining support from the staff is critical to success. Publicizing the program, how it works, and how to participate is further critical to see program success. D.3 Approaches and Policies After deciding what kind of issues to address, the next step is to design the program. Following the roadmap (Figure D-1), the agency must set priorities and decide on program components. Addressing health and safety issues may be a challenge because they require different kinds of interventions. Some items may overlap, because improving access to healthy foods and providing more regular access to restrooms can improve operator health and may lead to safer operating conditions, if indirectly. Adjusting schedules to ensure operators are well-rested could be particularly challenging when it comes to also providing adequate service to customers.

Implementation Memo D-3 Source: Gillespie, Wang, and Brown (2014) Figure D-1. Roadmap for transit health and safety. Each agency must decide on its policy priorities and design program interventions to achieve them. Focusing on one priority at a time will make it easier to focus on designing the appropriate interventions. Even if many programmatic elements are deployed, a clear goal will make it easier to evaluate the success of the program. The case study sites explored in the report provide many examples of health and wellness programs. Usually, these programs had an overarching goal of health improvements and offered various programmatic elements. Focusing on narrower goals might be a good idea: For example, if an agency identifies a high rate of type 2 diabetes, designing a program to specifically address this condition would make sense. If accident rates were rising at a particular agency, designing a program to improve safety operations would be important. Overall, a clear statement of purpose, partnership between management and labor, and buy-in from the workers are the keys to program participation. A successful program will provide services and activities that appeal to workers that, if used, will help them meet the program goal. D.4 Evaluation Measures There are several measures that transit agencies and unions can use to track the success of wellness programs at reducing costs, but measuring gains from the implementation of a wellness program may require a long lead time. Impacts on absentee hours, workers’ compensation, and reduced

D-4 Improving the Health and Safety of Transit Workers with Corresponding Impacts on the Bottom Line healthcare spending will take a long time to appear because they can only be addressed indirectly, with the possible exception of cases where the negative health aspects of a particular behavior are so extreme and widespread that an immediate change brought about by a new program would be realized quickly. For this reason, the process of tracking the success of the wellness programs at reducing costs should be initiated as soon as the program is implemented. As part of program participation, participants should be asked to allow the use of their de-identified data collected through other systems to evaluate the program. Simple surveys can be administered to all workers and program participants to fill in any gaps in system-level data. Pre- and post- participation surveys can be used to supplement the other data used in the evaluation. These surveys can gauge participant interest and provide qualitative data about the program. The best evaluations are randomized controlled trials (RCT), which require a control group that would continue as usual, and a treatment group that would have the opportunity to participate in the program. RCTs are a technically complicated research approach and are unlikely to be practical for transit agencies to undertake. We also do not recommend RCTs for health and wellness programs due to the likelihood of confounding variables. It is very difficult to control for the possibility that people participate in similar programs outside of the workplace. The more practical approach to evaluation, and what we used in the report, is to compare data from before the start of the program to that taken after it has been implemented for some amount of time. A well-designed “pre-post” evaluation would include several years of data before the program to develop a baseline that can be compared to the post-implementation measures. The goal is to compare data on the outcomes of interest before the initiation of the program and after the program has been operating for at least a year, but ideally 2–3 years. Having 2–3 years of data before the program is also ideal. Setting up systems that can collect and store individual-level data on the outcome of interest is a critical part of program implementation and will allow for robust evaluation. Setting up the systems successfully to accurately document the full extent of what actually transpires is challenging. Setting up the evaluation must occur in conjunction with formulating the program. Program coordinators should work in partnership with the evaluator(s); otherwise, the evaluation may be perceived as an unnecessary burden. Prior Transit Cooperative Research Program publications include resources to help design and track programs, such as the spreadsheet tool titled “Transit Operator Workplace Health Protection and Promotion Planning, Evaluation, and Return on Investment (ROI) Template.” (The spreadsheet file can be downloaded at no charge from the TCRP Report 169 webpage at www.trb.org.) Based on the research in this report, using the “Outcome” tab would be a good starting place to track the key measures the programs are meant to impact. The tabs for “Financial Benefits,” “Cost,” and “ROI” provide a way to track results. D.5 Summary A successful implementation can be achieved by combining a clearly stated policy goal and an evaluation plan. Implementation has several stages, of which some may be undertaken simultaneously, including determining goals, getting feedback from workers, and constituting a committee with labor and management representation to help design and oversee the program. Similarly, an evaluation must be an integral part of the planning process. An evaluation plan will

Implementation Memo D-5 success. Agencies must clearly define the ultimate goal of the program and make sure to design something that could plausibly achieve that goal. If indirect outcomes are desired, a clear trajectory from the intermediate goal should be determined before program implementation. With these pieces in place, an agency can be confident about their approach to implementation. help determine if the program has a positive ROI and if it needs modification. Agencies must make sure to plan the program carefully; buy-in from management, labor, and workers is essential to

Abbreviations and acronyms used without definitions in TRB publications: A4A Airlines for America AAAE American Association of Airport Executives AASHO American Association of State Highway Officials AASHTO American Association of State Highway and Transportation Officials ACI–NA Airports Council International–North America ACRP Airport Cooperative Research Program ADA Americans with Disabilities Act APTA American Public Transportation Association ASCE American Society of Civil Engineers ASME American Society of Mechanical Engineers ASTM American Society for Testing and Materials ATA American Trucking Associations CTAA Community Transportation Association of America CTBSSP Commercial Truck and Bus Safety Synthesis Program DHS Department of Homeland Security DOE Department of Energy EPA Environmental Protection Agency FAA Federal Aviation Administration FAST Fixing America’s Surface Transportation Act (2015) FHWA Federal Highway Administration FMCSA Federal Motor Carrier Safety Administration FRA Federal Railroad Administration FTA Federal Transit Administration HMCRP Hazardous Materials Cooperative Research Program IEEE Institute of Electrical and Electronics Engineers ISTEA Intermodal Surface Transportation Efficiency Act of 1991 ITE Institute of Transportation Engineers MAP-21 Moving Ahead for Progress in the 21st Century Act (2012) NASA National Aeronautics and Space Administration NASAO National Association of State Aviation Officials NCFRP National Cooperative Freight Research Program NCHRP National Cooperative Highway Research Program NHTSA National Highway Traffic Safety Administration NTSB National Transportation Safety Board PHMSA Pipeline and Hazardous Materials Safety Administration RITA Research and Innovative Technology Administration SAE Society of Automotive Engineers SAFETEA-LU Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (2005) TCRP Transit Cooperative Research Program TDC Transit Development Corporation TEA-21 Transportation Equity Act for the 21st Century (1998) TRB Transportation Research Board TSA Transportation Security Administration U.S. DOT United States Department of Transportation

Im proving the H ealth and Safety of Transit W orkers w ith Corresponding Im pacts on the Bottom Line TCRP Research Report 217 TRB TRA N SPO RTATIO N RESEA RCH BO A RD 500 Fifth Street, N W W ashington, D C 20001 A D D RESS SERV ICE REQ U ESTED ISBN 978-0-309-67361-7 9 7 8 0 3 0 9 6 7 3 6 1 7 9 0 0 0 0