Workplace cognitive impairment is a serious and sometimes confusing topic. The causes of impairment are varied, the effects mixed and remediation efforts, until now, have been difficult to implement.
This guide to Workplace Cognitive Impairment is designed to answer your questions and get your organization on the right track.
What are the Benefits of Cognitive Impairment Testing?
Despite early struggles in bringing impairment tests to the workplace safety market, the benefits of using impairment tests have always been clear and profound.
The main benefit of impairment testing is its ability to function as an agent of change towards a more positive workplace culture. This comes as an inevitable consequence of the smaller changes it sparks:
Workplace Impairment Testing Allows for More Personal Feedback
At the end of each impairment test, the worker receives instant feedback concerning their state of mind and ability to work safely.
This instant personal feedback empowers workers to take responsibility for their own safety, increases their awareness in identifying key human factors behind workplace incidents, and allows them to make better safety decisions.
For example, one large transportation company reported that after implementing the AlertMeter® as a daily pre-shift impairment test, workers began utilizing that feedback to make lifestyle changes in order to arrive to work more alert and well-rested:
"The feedback it gives to our employees motivates them to take responsibility for their off-time lifestyle behavior. They are definitely arriving more alert and more rested than they used to.”
Workplace Impairment Testing Prompts More Safety Conversations
Many supervisors do not have the time to meet with each of their workers to make sure they are doing well mentally, physically, and emotionally each and every day.
Even if they do have the time, they may be hesitant to be overly intrusive when they notice a worker may have something on their mind. After all, everyone has their personal problems and it's difficult not to bring them into the workplace.
Impairment tests give supervisors an objective starting point to begin important safety conversations with just the right workers at just the right times. They promote and enforce better leadership qualities amongst supervisors and managers who are prompted into more effective engagement and communication with their workers.
If a worker is unable to perform within their normal baseline on the impairment test, usually a supervisor is notified to investigate the cause of the issue.
Since the impairment test will not reveal the cause of impairment, supervisors must utilize their communication and empathy skills to identify and address the problem in a positive and proactive manner.
Ultimately, workers feel heard and supported. Supervisors save valuable time by focusing their attention where it's most needed. The objective and non-intrusive nature of the test allows all of this to take place without any hurt feelings.
An employee scored abnormally on two consecutive tests, triggering a notification to a supervisor. In the conversation that followed, the supervisor learned that the employee’s father had passed away the day before. (Stories from the Field).
Workplace Impairment Testing Provides Increased Insights into the Underlying Causes of Human Error
Until modern-day technology made workplace impairment testing accessible and efficient in workplaces, drug testing was the sole objective measure of the myriad factors behind human error.
This means workplaces had a much narrower understanding of what constituted a "fit-for-duty worker."
As long as they had their training and didn't have drugs in their system at the time the drug test was taken, they were considered "fit-for-work."
With the advent of impairment testing, workplaces suddenly received much more insight about a plethora of factors constituting worker impairment. Since you can't manage what you don't measure, they could now begin managing much more common sources of impairment like fatigue and emotional distress.
All of a Sudden, Accidents Became a lot more Predictable and Preventable
An employee scored abnormally on two consecutive tests, triggering a notification to a supervisor. A conversation revealed that the employee was having difficulty seeing the shapes on the AlertMeter® screen with his new prescription glasses. The supervisor determined that the employee’s new prescription may not be appropriate, which could present a safety hazard. The supervisor advised that the employee return to the eye doctor. (Stories from the Field).
Workplace Impairment Testing Increases Worker Awareness about how to Address Underlying Causes of Human Error
With the instant feedback and insights provided by impairment testing, workers are now given greater responsibility and motivation to make better decisions concerning their own health and safety.
Often, a worker who is severely impaired does not realize he/she is impaired.
This is typically apparent in drug and alcohol impairment. However, it is also true in cases where fatigue or emotional distress are involved.
Willful blindness also plays a role here.
There are many reasons why workers may feel compelled to turn a blind eye to cognitive impairment:
- They need to earn their wages
- They don't want to waste their days off
- Sometimes they want to get their mind off personal problems
Other times they've been conditioned by society and culture to appear tough and hardworking, and thus shrug off their mental or emotional struggles. "I'll sleep when I'm dead" or "Early bird gets the worm," for example, are popular mantras that fuel a dangerous disregard for cognitive impairment in workplaces.
When companies start utilizing impairment testing, workers recognize daily the impact of cognitive impairment on their behavior. Once they recognize it as an important issue, and become more aware of its impact on them, they take steps to mitigate or avoid it. One study found that 20% of workers using impairment testing reported getting more sleep and drinking less alcohol. Workers have also reported spending less time watching Netflix late at night, and making greater efforts with their families to prioritize restorative sleep each night.
"An employee came in one morning, struggling with the AlertMeter® game, so the supervisor asked him if anything was wrong. Apparently the evening before, his teenage son had to be taken to the emergency room because his son has some sort of terminal illness. The guy was in the hospital all night with his kid, and he shows up for work the next day. The supervisor asked him, 'Why in the world are you here?' The guy’s response was, 'I’m the breadwinner of the family, I’ve got to earn a paycheck.'
This particular employee operates a 100-ton crane. Especially in the steel business, we’ve got a lot of tough guys out there. Prior to using the AlertMeter®, we probably would have never known his state of mind that day. When you think that through, I can’t tell you for sure an accident would have happened, but I can tell you we were able to take steps that day to keep an employee from hurting himself or others." (Stories from the Field)
Workplace Impairment Testing Increases Empathy and Trust Amongst Workers
As mentioned, when workplaces have a way to measure previously undetected human factors, they not only become more aware of their own vulnerabilities but also more understanding of their coworkers' vulnerabilities.
Each shift, workers take their impairment test. Most of them do well and receive instant feedback that they are cognitively fit-for-work. On occasion, one worker will not be able to perform the test as he/she usually does. Workers gain visibility into the impacts of impairments like fatigue and distress on their coworkers, understanding that it can affect everyone at some point. Workers on close-knit teams often share the source of their impairment with their coworkers--a sleepless night, an ill family member, or some troubling news. This allows coworkers to empathize with one another, learn to prioritize each other's mental and physical wellness, and be supportive instead of judgmental.
Conversely, when all workers receive the pre-shift confirmation that they are fit-for-work, they feel greater trust for one another. In jobs when the fate of one worker rests on the ability of another to focus and do his job right, the ability to trust one another is a tremendous relief. Trust is so important to these workers that, if a worker is unwilling to take their impairment test one day, the others will actively encourage that they take it.
Employees at one workplace started sharing their daily AlertMeter® performance results with workmates to prove that they are ready and able to work safely around each other.
Workplace Impairment Testing Fosters Safety Through Support Rather than Punitive Measures
Daily visibility into human impairment requires the implementation of supportive rather than punitive measures.
By adopting a top-level perspective on impairment, supervisors are forced to be supportive and communicate effectively in order to identify the cause of impairment.
Cognitive impairment is complex and can involve a variety of causes. Working conditions, shift schedules, workplace culture, and team dynamics can all contribute to exacerbating worker fatigue, distress, and distraction.
This means that instead of approaching impaired workers with a disciplinary mindset, supervisors are forced to recognize the degree to which factors outside the worker's control may have contributed to his/her impairment.
Ultimately, by being supportive instead of punitive, supervisors are able to create a learning opportunity for both the worker and for the management of the workforce.
These learning opportunities can lead to improved shift scheduling, more timely breaks, more comfortable PPE, more access to water and/or coffee, and more comprehensive safety training and resources.
"The trucking personnel now realize that,
'We want them to be healthy, able to do their job while also having a life outside of work. There is an expectation that they are following sleep guidelines, maintaining healthy eating habits, and generally taking care of themselves. They're not just workers with a pulse. We want them to be healthy and strong, have a lengthy career, and be able to spend time with their families outside of work'" (AlertMeter® Transportation Case Study).
Workplace impairment testing enforces a heightened sense of personal responsibility and accountability for safety.
Instead of blaming an incident on being too tired or being distracted by something, workers realize that these factors are now within their awareness and, therefore, within their control.
A study cited by EHS estimated that between 60-80% of workplace accidents can be attributed to stress-induced issues like a distraction. (EHS)
If a worker has daily insight into how factors like stress are contributing to his/her impairment, they begin to engage in countermeasures to alleviate this stress, including making lifestyle changes that promote their health and well-being.
"Q. Has [impairment testing] changed employees’ lifestyles overall?
Employees have told me that they’re taking better care of themselves now such as getting more sleep. One employee said his family traditionally had a BBQ every Sunday night with a fair amount of partying. They’ve changed it to Saturday night so he’s better rested for work." ("Why Triple-S Steel Uses AlertMeter®")
By beginning each shift with this heightened sense of accountability and control over their own safety, workers are also more likely to approach all their daily tasks with safety top of mind.
Workplace impairment testing reduces worker fear of speaking up or asking for help.
These greater cultural changes in the workplace mean that workers are no longer afraid of speaking up or asking for help when they may be struggling with impairment. They understand that cognitive impairment impacts everyone at some point, and they must do everything in their own power to address it before it becomes dangerous. With safety top of mind, workers and supervisors work together to reduce risks and address problems in a proactive and unified manner.
"The interaction between our leadership team and our employees from a safety perspective has just gone through the roof. It has increased everyone’s safety awareness." ("Why Triple-S Steel Uses AlertMeter®")
Workplace Impairment Testing can Lead to a Reduction in More Invasive Safety Measures
For example, one manufacturing company that adopted impairment testing with the AlertMeter®, reduced their drug testing costs by 90% by completely doing away with random drug-testing. Although other companies in other industries or locations may unable to alter their drug-testing practices in such a drastic fashion, an effort to also include non-invasive safety measures can help reduce dependency and negative attitudes towards invasive ones. By not only relying on invasive measures of impairment, but workplaces can also unwittingly send the message that control over workers' lives and punitive action are essential components of your safety system. By diversifying and modernizing your safety program with a more positive and worker-friendly safety measure, workplaces can drive home the point that safety is the goal, not control or discipline. The communication and empathy sparked by the implementation of an impairment test like the AlertMeter® can further be used as an opportunity to address worker concerns and dispel negativity towards your other safety practices.
Workplace Impairment Testing can Help Reduce Negativity and Resentment Among Workers
Despite the fact that new technologies are often met with suspicion and hesitance among workers, impairment tests have been accepted with surprising positivity even in their early days.
According to research by the National Workrights Institute:
- 100% of employers who used impairment testing considered their experience successful.
- 82% of employers found that impairment testing improved safety.
- 90% of employees accepted impairment testing.
- 87% of employers found impairment testing superior to urine testing.
These survey results are indicative of the rapidly changing attitudes towards drug testing in light of cannabis legalization, increased social and cultural pressures on workplace safety, and the availability of less invasive technologies that achieve more insight in less time.
Even before impairment tests were a reality, using drug testing as a safety procedure seemed to be quickly getting outdated and ineffective.
So, how do companies who use impairment testing leverage it against their corporate and legal drug testing policies?
How do the two fit together? Do they fit together?
By recognizing the strengths and weaknesses of both impairment testing and drug testing, you can implement a solution in your workplace that drives safety and positivity forward without neglecting your responsibility to the law.
More Resources:
Analyzing Fit for Work in the Top 5 Most Common Workplace Accidents
What's the Science Behind Impairment Testing?
How AlertMeter® Fits into a Workplace Drug and Alcohol Testing Program
What is Occupational Impairment? Here's Why Drug Testing Isn't Enough
What Occupational Impairment Tests are Available Today
Will Employees Buy-in to an Impairment Test Program
69% of Your Employees Are Drunk at Work
Signs of Impairment in the Workplace
Workplace Impairment Policy to Reduce Errors and Increase Productivity at Work
How AlertMeter® Fits into a Workplace Drug and Alcohol Testing Program
NSC Impairment Detection Technology & Workplace Safety Report
Recognizing Impairment in the Workplace
What Occupational Impairment Tests are Available Today
Impairment in the Workplace - How Does Impairment Testing Compare to Drug Testing?
Is Workplace Impairment Testing Right for Your Company?
References
Basner, Mathias, and Joshua Rubinstein. “Fitness for duty: a 3-minute version of the Psychomotor Vigilance Test predicts fatigue-related declines in luggage-screening performance.” Journal of occupational and environmental medicine vol. 53,10 (2011): 1146-54. doi:10.1097/JOM.0b013e31822b8356
Butler B, Tranter D. Behavioral tests to assess performance. In: Macdonald S, Roman P, editors. Research Advances in the Workplace: Volume 11. Drug Testing in the Workplace. New York: Plenum Press; 1994. pp. 231–255. [Google Scholar]
Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1external icon.
Dawson, D., Reid, K. Fatigue, alcohol and performance impairment. Nature 388, 235 (1997). https://doi.org/10.1038/40775
ECA. (2016). Problematic substance abuse in aviation: Testing & peer support programmes. European Cockpit Association AISBL. Retrieved from https://www.eurocockpit.be/sites/default/files/problematic_substance_
use_prevention_in_aviation_eca_position_pp_15_1120_f_1.pdf
Fell, James C, and Robert B Voas. “The effectiveness of a 0.05 blood alcohol concentration (BAC) limit for driving in the United States.” Addiction (Abingdon, England) vol. 109,6 (2014): 869-74. doi:10.1111/add.12365
Lamond N, Dawson D. "Quantifying the performance impairment associated with fatigue." J Sleep Res. 1999 Dec;8(4):255-62. doi: 10.1046/j.1365-2869.1999.00167.x. PMID: 10646165.
Maltby, L. (2010). Impairment testing—Does it work? National Workrights Institute. Retrieved from http://www.workrights.org/nwi_drugTesting_impairmentTesting.html
Seijts, G. H. & O’Farrell, G. (2005). Urine collection jars versus video games: Perceptions of three stakeholder groups
toward drug and impairment testing programs. Journal of Drug Issues 35(4): 885–916. doi:10.1177/002204260503500411
Zhang, Jiawei. "Cognitive functions of the brain: Perception, attention and memory." arXiv preprint arXiv:1907.02863 (2019).