The Wrist Watch:
How a Plant Handles
With Common Sense
Many Small Changes Enable
Sara Lee Bakery to Ease
Carpal Tunnel Syndrome
Special Stools, Custom Tools
By Joan E. Rigdon
The Wall Street Journal
(Copyright (c) 1992, Dow Jones & Co., Inc.)
NEW HAMPTON, Iowa -- The problem began with some special
orders at the bakery. Customers wanted croissants whose tips curled
forward and touched.
When Sara Lee Corp.'s bakery in this rural town started making them,
and also filling orders for hand-decorated cakes, its workers had to twist
their wrists more than before. At first no one noticed. Employees,
standing on concrete floors with their arms extended over conveyor belts,
even raced one another at times, with winners handling almost 100 pieces
a minute. "They wanted so many and we went so fast, faster and faster,"
recalls one worker, Carol Panoch.
Their prize: carpal tunnel syndrome, a debilitating wrist disorder caused
by repeated hand motions. It and other so-called cumulative trauma
disorders caused by repetitive motion today make up the fastest growing,
most widespread U.S. occupational hazard, according to the Bureau of
Labor Statistics. Cumulative trauma disorders, or CTDs, afflicted
185,400 American workers in 1990, almost nine times the number
reported for 1982.
Symptoms suffered by the bakery workers here were typical: shooting
pains in the arms, numb and tingling fingers and aching wrists. Some
workers wore splints to work or bed. Some had surgery. The town's
small hospital leased a deluxe physical therapy machine to help handle the
But today, five years after that machine was purchased, it is more or less
foreign to Sara Lee workers. While hundreds of U.S. businesses, from
manufacturing plants to data-processing centers, continue to grapple with
complaints of CTDs, the bakery here has nearly eliminated them. It did so
-- after an initial balky start -- by using a homespun approach that
stresses prevention and relies on close observation of work procedures
and small modifications in them.
The bakery hired a hand surgeon to come in and evaluate its procedures.
It brought its labor union into the game. Instead of buying new equipment
off the shelf -- ergonomically designed chairs and keyboards for offices
can cost $100 to $1,000 a pop -- it used its own maintenance
department whenever possible to make dozens of small changes. In some
cases, workers themselves invented devices they thought would alleviate
problematic physical motions. For instance, one engineer devised a new
icing gun that weighed less and took less strength to squeeze.
The result is that employees missed only eight days of work because of
carpal tunnel syndrome in the first seven months of this year, after being
out 181 days during all of last year. The local union is generally pleased
with the bakery's response. "They've made great progress," says Bob
Schilling, the local business agent for the Bakery, Confectionary &
This is not to say the Sara Lee bakery has been a paragon of
enlightenment. Like many businesses, it was initially quite skeptical of
workers' seemingly vague complaints in the early-1980s -- even though
another, non-food unit of Sara Lee Corp. had been cited by the
Occupational Safety and Health Administration as long ago as 1979 for
conditions conducive to carpal tunnel syndrome. Bakery workers' early
suggestion to slow down the production line was dismissed out of hand.
Nor is the Sara Lee bakery here the only business at the forefront in
combating the problem. Facing lawsuits and huge government fines, many
other plants have also changed procedures. In the past decade, unions
have prodded meatpackers and auto makers to finance studies and
redesign work stations.
What distinguishes this Sara Lee bakery is that it tackled the problem
before it became epidemic. The majority of companies either do nothing
about complaints of repetitive motion injuries or offer limited treatment,
such as mandatory stretching exercises. This is so even though carpal
tunnel and other CTDs are a costly and growing problem. They made up
nearly 56% of work-related illnesses in 1990, according to the Bureau of
Labor Statistics, compared with 21% in 1982. And the CTD cases cost
an average of $29,000 in lost wages and medical treatment, says the
National Council on Compensation Insurance. That doesn't include legal
damages, which have been averaging $50,000 per plaintiff, or fines levied
by OSHA, which have been as high as $3 million.
"When people are off work for four, six and eight weeks and have
surgery and perhaps end up with a small amount of permanent disability .
. ., it doesn't take long to demonstrate that you can be cost-effective by
investing to keep claims down," says Ray Wright, former personnel
director of the Sara Lee bakery in New Hampton. The 630-employee
bakery estimates that its preventive approach to carpal tunnel syndrome
now saves it up to $750,000 a year in costs of worker's compensation
and lost labor.
The first complaints of wrist pain here arose in the early 1980s, and they
drew little attention from management. Local doctors couldn't diagnose a
problem, and workers felt they were written off as complainers. Tony
Gotto, the bakery's personnel director and then the safety manager, says,
"We had supervisors and co-workers who did not buy in because there
was no sign of injury." Marlene Lindell, who was the bakery's safety
nurse until 1990, agrees that the hardest part about fighting carpal tunnel
was "persuading management to look and see what the cause was."
When employee Carol Brockway first complained of shooting pains in
her arms in the early 1980s, she feared her bosses thought, "What's she
trying to pull? Is she trying to get off work or trying to get paid off?" For
four years, she complained to Ms. Lindell and local doctors, but all she
got was conflicting diagnoses of muscle disorders and a cortisone
But in 1986 the bakery recruited a hand surgeon from Cedar Rapids,
some 100 miles to the south, who talked about preventing the symptoms
instead of just treating them. William Eversmann operated on the bakery's
early cases, including Ms. Brockway. He also visited the bakery, where
he timed the number of worker wrist actions per minute and the weight of
various doughs and tools. He measured table heights and photographed
workers stooping, stretching or flicking their wrists to do their work. He
showed the photos to the managers and asked them to suggest ways
employees could do the work without using awkward postures.
Based on the doctor's recommendations, the bakery made a few
changes, including slowing down fast workers while asking others to
speed up to 60 pieces a minute. It also added one worker to a
production line that had a lot of problems. Workers were already rotating
jobs, but on Dr. Eversmann's advice, they made a point of alternating
harder jobs with easier ones. Also, Dr. Eversmann presented a slide
show using photographs of the workers themselves, to explain the
But the program was a flop with workers. Confused by the technical
terms in the slide show and dubious about "the company doctor,"
workers watched in fear as colleagues who reported symptoms headed
into surgery and then disappeared for weeks or months to recuperate.
Fearful that all cases would result in surgery, some avoided reporting their
symptoms, thereby increasing their own eventual need for surgery.
Many workers objected to Dr. Eversmann because he wasn't a specialist
in ergonomics -- the study of how people physically adapt to their
working environment -- with experience in a wide variety of fields. But he
was the closest thing to an expert in the region, bakery officials say, and
had done ergonomics work at a meat plant (not owned by Sara Lee).
"You've got to work with the resources that are available," says Mr.
Gotto, the former safety manager.
Workers also objected to having to make the unpaid, four-hour round
trip to Dr. Eversmann's office, sometimes through ice and snow and
sometimes before or after a full day's work. They asked for permission to
see other doctors who worked closer by, but the bakery didn't know of
any then, Mr. Gotto says.
The ill-feelings, along with union objections on other issues including a
two-tier pay system, boiled over into a two-week strike in March of
1990. "People wanted the dignity of being able to choose their own
doctor," says Jan Laue, then a union official involved in carpal tunnel
issues at the plant.
Under a new contract, the company agreed to use two additional
doctors, in towns only 40 miles away, and to pay workers for up to four
hours of driving time per round trip to the Cedar Rapids doctor. The
bakery also put its carpal tunnel policy in writing.
But the big change was the formation of a cumulative trauma disorder
committee of four managers and four union-selected employees. "If we
made any errors in setting up our program, it was not involving our union
early on," says Mr. Gotto.
With the committee and a choice of doctors, workers say changes moved
forward quickly. Tapping its own maintenance department, the bakery
raised and lowered tables and conveyor belts and made stools for
workers who used to stoop. Mats made it easier to stand on concrete
floors for entire shifts. Foot rails allowed them to shift their weight instead
of standing in the same position all day.
Workers pitched in by ordering or inventing new tools that were easier to
work with. Razor-edged plastic scrapers, used to get batter out of mixing
vats, were replaced with scrapers with handles. Acrylic putty on tool
handles, which workers formed in their hands and let harden, gave each
worker a custom fit. And workers punched handles into plastic buckets
that they previously picked up by jamming their fingertips against narrow
Also, the committee changed the way employees worked. Conveyor
belts were moved closer to workers who previously leaned forward.
Pallets were stacked close to conveyor belts so it wasn't necessary to
carry items between the two. Workers learned to carry large pans on
their forearms instead of grasping the pans by their edges, which puts the
entire weight on the wrists.
Through a buddy system, veteran workers now show rookies the most
comfortable way to work, although that's sometimes difficult to do
without seeming nosy.
Because it's difficult to remember all the correct postures while working
on the assembly line, the CTD committee sometimes prowls the plant,
photographing workers to point out harmful postures. The bakery also
checks all workers annually for signs of carpal tunnel syndrome; it uses a
machine called a vibrometer to see whether any loss of sensitivity is
developing in the fingertips.
The results have been significant: Last year just 13 suspected carpal
tunnel cases were referred to outside physicians at the bakery, compared
with 34 in 1987. And absenteeism related to the disorder has plunged;
the eight work days lost through Aug. 1 of this year present a stark
contrast with 1987, when, for the full year, 731 work days were lost.
Still, union officials fault the bakery for scrimping on the services of a
bona fide ergonomist and for not buying expensive automated equipment
for one production line to load heavy pans. (Mr. Gotto says the bakery
sees to it that workers don't have to lift the pans for more than half an
hour at a time.)
Moreover, they hardly view the parent Sara Lee Corp. as devoted to a
safe workplace. OSHA cited its Hanes underwear plant in Galax, Va.,
13 years ago for conditions leading to tendinitis, carpal tunnel syndrome
and other CTDs. In 1990, OSHA cited Sara Lee's bakery in Traverse
City, Mich., for essentially the same thing. And just last May, the federal
agency cited Sara Lee's Seitz Foods meat-processing plant near Kansas
City for not adopting an ergonomics program it had agreed to institute
years earlier, in exchange for a temporary reprieve from OSHA
inspections. Asked about this and why Sara Lee didn't develop a
corporatewide CTD program after the Hanes case, company officials at
headquarters in Chicago decline to comment.
Says Ms. Laue, the former union official: "The solution isn't to go through
one worker after another. If the job is injuring the worker, the job needs
to be changed."
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