4 Steps to Fatigue Risk Management - a Fatigue Risk Management Template

Workplace fatigue awareness has been on the rise ever since fatigue was found to be a contributing factor in incidents like the Exxon Valdez oil spill, the Chernobyl disaster, and the Challenger explosion. Many of today's safety-sensitive workplaces recognize the risk, costs, and dangers associated with workplace fatigue. For example, lost productivity due to fatigue is estimated to cost employers $136 billion a year. (NSC)

However, despite the increased research and awareness of workplace fatigue risk, it continues to go largely unmanaged. The technological solutions required to effectively manage workplace fatigue are still fairly new. This article will identify 4 essential steps in workplace fatigue risk management so that workplaces can better evaluate their fatigue management needs and implement a fatigue risk management system that suits their industry and workplace culture.

The 1st Piece of a Fatigue Risk Management Template

Education is clearly the first step in any type of program that challenges daily habits that may be unsafe or unproductive (energy-drink binging, inadequate rest, etc.); uproots harmful cultural beliefs (taking pride in working excessive hours, sleep deprivation, and overexertion); and influences a more positive workplace culture. 

Before implementing a fatigue risk management system, it is critical that everyone in the workplace understands the meaning of "workplace fatigue." How the word 'fatigue' is used in daily life does not inspire a full appreciation of the wide variety of factors that contribute to workplace fatigue; the severity of the damages it inflicts on workplaces each year; and how it impacts the lives of dedicated shift-workers everywhere. 

What Is Fatigue?

• Fatigue is mental or physical exhaustion that stops a person from being able to function normally.
• Fatigue involves “a state of impaired mental and/or physical performance and lowered alertness” (1).
• Fatigue can be caused by "a combination of hard physical and mental work, health and psychosocial factors or inadequate restorative sleep" (7).
• Fatigue can be either work or non-work related or a combination of both.
• Fatigue often results in increased difficulty in performing physical or mental activities.

Although these definitions describe fatigue individually, "workplace fatigue" is more complex than it may imply.

Workplace fatigue involves a different variety of aggravating factors — shift schedules, commutes, etc.— and has farther-reaching risks than at the individual level — safety-critical tasks, productivity, and worker burnout. 

To understand the meaning of fatigue in a workplace context, see the following graphic which accounts for the three major factors in "total worker fatigue." 

What Is Workplace Fatigue?

As seen above, workplace fatigue is not simply a measure of how long your workers have been sleep-deprived.

Instead, a definition of workplace fatigue that is conducive to effective management will recognize the influence of other factors such as the health status of your workers; the heat and noise levels in your workplace; the number of consecutive night shifts worked, etc.

Here is another way to envision the factors behind workplace fatigue. It is important to consider these factors in determining the fatigue risk that your workers may be subject to:

What is the Circadian Rhythm?

One of the major factors contributing to worker fatigue particularly related to shift work is the disruption of the circadian rhythm. The human biological system operates on an internal clock in which different functions run on different cycle lengths. The circadian rhythm, for example, is a rhythm that cycles approximately every 24 hours, with various functions either rising or falling at various times throughout the 24-hour period.

For example, high body temperature and heart rate are associated with increased alertness and performance and occur during daylight hours. Sleep, on the other hand, is associated with a lowering of body temperature, heart rate, and cortisol, which decrease in the evening, then rise in the morning before we awaken. ⁽³⁾

The physiological tendency to sleep at night and to be awake during the day is powerful; difficulties occur when work-time arrangements cause individuals to work against this tendency. Altering the normal sleep/wake cycle affects both the ability to remain alert and the ability to sleep. Non-traditional work hours (night or early morning) create a misalignment between the internal clock on normal activity and sleep schedule. ⁽⁴⁾

The circadian rhythm also creates natural fatigue zones that occur usually around 2:30 PM and 4:00 AM. Given that all humans encounter these natural fatigue zones, shift workers experience an even more difficult fatigue challenge. Retraining our internal, built-in “body clock” is not easy, and shift work creates what is called “circadian desynchronization.”

Shift workers’ circadian rhythm is out of step with the environment, and no matter how hard they try, they will always struggle to adjust to new work-and-rest schedules. 

In fact, everyone’s circadian clock adjusts at slightly different rates, so a common effect of shift work, especially among workers on rotating shifts, is “jet lag.” Even workers who work only at night experience this circadian lag every week, beginning on their days off. There are additional calculating factors in a formal fatigue risk assessment.

To ensure your shift schedules and circadian rhythm disruption are not contributing to fatigue levels in your workplace, get a fatigue risk shift schedule assessment here.

Get the Guide!

These shift assessments measure the impact of factors like:

• shift patterns
• how breaks are organized
• countermeasures for fatigue mitigation
• review of employee health issues
• lifestyle questionnaire
• night shifts vs. day shifts
• shift lengths
• consecutive days worked
• days off between work cycles
• days off between day-night shifts 
• frequency of night shifts
• workplace environment: temperature, noise, access to water and snacks
• worker commute times
• job role and safety-sensitivity 

After assessing the influence of these factors, the shift schedule assessment will provide a new shift schedule optimized for the highest worker alertness, a fatigue heat map to highlight the days and times fatigue might be high, and appropriate countermeasures to combat high fatigue risk. This type of assessment takes approximately one week, and up to two additional weeks to analyze the data and compile the results. Once completed, the findings and recommendations are presented to management.

Why Manage Workplace Fatigue? 

After raising awareness of the factors that cause workplace fatigue (click here for helpful fatigue infographics you can hang in your workplace), the next step is to educate various decision-makers in the organization about why fatigue management is a critical part of company success. 

Start with the negatives (Unfortunately, humans find negativity more provocative than the prospects of positive change.):

Workplace fatigue results in:

• Reduced performance and productivity
• Increased risk of accidents and injuries
• Impaired worker judgment, is an especially disastrous symptom for safety decision-makers
• Reduced worker self-awareness (Fatigued workers are unable to gauge their own level of impairment. As a result, they are unaware that they are not functioning as well or as safely as when they're fully alert. This leads to poor decision-making, burn-out, and low morale.)

If your organization offers healthcare benefits and generally takes an interest in the well-being of their workers, the effects of fatigue on an individual level are also worthy of mention: 

• Short-term cognitive effects: Impaired memory, concentration, vigilance, reaction-time
• Short-term health issues: Increased stress, depression, and reduced immune strength
• Short-term outcomes: Increased absenteeism, presenteeism, burnout, higher incident frequency, increased errors
• Long-term health issues: Digestion problems, heart disease, increased risk of cancer, obesity, and more
• Long-term outcomes: Increased turnover, reduced productivity, increased insurance rates, increased safety costs

(Infographic from healthline.com)

The 2nd Piece of a Fatigue Risk Management Template

Sometimes, it may be easy to recognize fatigue.

For example, when you find a worker asleep on the job or do a root cause post-incident analysis and find that the operator involved in the incident had been at the end of a 12-hour night shift on his 4th consecutive night shift. 

A more important yet more difficult challenge is to recognize fatigue before it leads to an incident or before someone falls asleep.

This requires looking beyond objective factors like shift length and sleep hours and assessing the involvement of more subjective causes of fatigue such as:

• an employee’s private commitments (other jobs, family crisis, etc.)
• sleeping or eating habits (including any sleep disorders)
• other individual characteristics.

Supervisors who are too busy to measure the significance of subjective fatigue risk factors on their workers can use technology to do so. A non-invasive 60-second test, the AlertMeter® notifies a supervisor when a worker may be cognitively impaired and needs attention. The conversation that ensues is quick and painless and contributes to better safety communication, better relationships, and a more positive safety culture. Click here to read examples of those conversations. 

How Is Fatigue Detected?

Understanding the “progression of fatigue” helps us see why it is so important to focus on measurement before management. While we expect employees to arrive at work at full alertness level, as many employees do, this optimal condition doesn’t always happen and may not actually be possible for all workers.

At moderate alertness levels, fatigue begins to negatively impact certain aspects of worker performance.

At reduced alertness levels, fatigue has detrimental effects on worker productivity and safety.

Unfortunately, it is not until the point of failure where fatigue has caused or contributed to an incident or a near miss that we tend to focus on solutions, controls, or other ways to “manage” fatigue risk.

Each of these factors are quantifiable and able to be measured in our attempt to manage fatigue in the workplace:

• De-synchronization of sleep/work cycle with circadian rhythm: Trying to work when the body is in a sleep cycle or trying to sleep when the body is in an active cycle
• The build-up of sleep debt over sequential shifts: Insufficient sleep between shifts to completely reset sleep debt
• Total hours/shifts worked: Moving the circadian cycle backward increases fatigue risk; the insufficient time between shift pattern
  changes

The 3rd Piece of a Fatigue Risk Management Template

After educating ourselves on the multitude of factors that could cause or contribute to fatigue, and realizing how important it is to measure or detect fatigue, companies can move toward proactively managing or applying countermeasures to fatigue risk in the workplace.

Managing fatigue presents 3 primary challenges:

1. First, there is no objective, standard definition of fatigue until the point of failure.
2. Second, fatigue is a non-static variable, making it difficult to measure.
3. And third, a majority of behaviors impacting fatigue are not work-related and occur outside of the workplace.  

We can think of fatigue as an input variable in the organization’s workstream: 

• Fatigue impacts the quality of an organization and its results;
• It is inherent within all human resources;
• It impacts worker health, often leading to absenteeism and workplace accidents.

Using “Cost of Quality” concepts, we can apply a Quality Improvement Model:

The Cost of Quality is a business model that shows how continuous improvement efforts reduce future costs.

Larger investments in prevention end up driving even larger savings in quality-related failures down the road.

By investing in prevention, companies can address problems at the source and prevent future expenses that are exponentially higher when addressing them downstream, or after an incident occurs.

The 1-10-100 Rule is a business efficiency model that can be used in qualitative analysis. Basically, it looks at the cost of prevention compared to the costs of correction, compared to the costs at our after a point of failure. 

When we apply these models to our interest in managing fatigue, it becomes clear that an investment in measuring and managing worker fatigue is going to reduce potential costs and risks of failures related to fatigue in the workplace.

Here’s another way to look at the benefits of managing fatigue from a Cost of Quality perspective. The investment, both in cost and effort, before deciding to manage fatigue shows: 

• Low focus on human factors
• High expense at the point of failure
• Little correlation to total environment 

Most of this deals with responding to points of failure; a company’s reactions to workplace incidents; whether resulting in property damage, first-aid injury, lost time, workers’ compensation, lost productivity, a more serious injury, or fatality.

The investment both in cost and effort after deciding to manage fatigue shows a much more balanced distribution across education and fatigue risk management efforts.

It also provides a high focus on human factors, better visibility to fatigue risk, and robust data reporting and analysis. But most importantly, there is a significantly smaller point of failure cost.

The benefit of prevention efforts, like education and other fatigue management activities) clearly outweigh the costs associated with failure.

Fatigue Countermeasures

Part of managing fatigue is appropriately using countermeasures to reduce fatigue’s effects and to enhance or encourage alertness.

Countermeasures can be behavioral, meaning recurring or routine actions that encourage alertness, or they can be nutritional, related to the intake of food or drink.

• Staying hydrated is key. Dehydration accelerates fatigue symptoms, so access to potable water must not only be ensured but used frequently. Plus, employees can use clean, cold water to refresh themselves by washing their faces and hands.
• Staying mobile is also a behavioral countermeasure that can fend off fatigue symptoms. For workers who sit for long periods, taking frequent short walks and stretching is advised. For employees who are active, brief intervals of isometric exercise can help keep the body fresh and the mind alert. If possible, brief periods of rest or sleep can also reinvigorate a fatigued worker. Some workplaces may also provide “light stations,” where employees can combat fatigue symptoms by bathing in bright white light.
• Besides hydration, nutritional countermeasures include consuming caffeinated beverages, like coffee or tea, and energy drinks and soft drinks in moderation.
• Although they may boost energy levels, energy drinks should be used sparingly because they contain very high doses of caffeine and other stimulants. When consumed to excess, they can disrupt nightly sleep and actually contribute to daytime fatigue (which may then lead to consuming more energy drinks). However, reasonable doses of caffeine taken at appropriate intervals can be appropriate countermeasures to fatigue symptoms. In addition, food intake and nutrition is important. Foods that are high in fat and carbohydrates, including sugars, should be restricted; instead, fatigue symptoms can be better managed with nutritious and protein-rich foods, like protein bars, nuts, and dried fruit.

A simple countermeasure strategy for employees to follow can empower them to manage their own fatigue symptoms as well as maintain their autonomy. Behavioral countermeasures are either recurring or occasional (once a shift), and employees can tailor their nutritional countermeasures according to their needs and preferences, except that they should always limit their intake of foods high in carbohydrates and fats.

The 4th Piece of a Fatigue Risk Management Template

How Is Fatigue Risk Continuously Managed?

Management is a process, not a goal. To manage any program or system effectively, ongoing monitoring, evaluation, and adjustment are required. 

The need to measure and maintain holds true for fatigue management.

Ongoing evaluation is necessary to determine whether a program or system remains effective and relevant. Ideally, fatigue management should rely on a balance of leading and lagging indicators. 

Two examples of leading indicators are:

• the number of individuals diagnosed with and treated for sleeping disorders
• and the number of individuals who self-report fatigue when at work.

Lagging indicators include:

• Incident and accident rates
• Equipment damage,
• Feedback from employees.

Three great ways to get started with fatigue measurement, management, and monitoring are:

1. Measure: Take a Fatigue Risk Assessment to calculate site-level risk and identify individual risk profiles.
2. Manage: Implement the results of the assessment and manage daily alertness with a pre-shift or pre-task alertness testing protocol.
3. Monitor: Implement other management tools, such as biomathematical fatigue prediction software with built-in countermeasures and timely notifications.

By going through all three steps, you can make better scheduling decisions and proactively reduce fatigue risk:

• You can make shift scheduling more “bio-compatible,” or more suited to employees’ circadian rhythms. For example, workers who generally demonstrate higher alertness levels in the evening than others can be scheduled for evening shifts.
• You can reduce fatigue risk during “fatigue zones,” or circadian ebbs. Fatigue zones are two 4-hour stretches in a 24-hour period, from 3:00 a.m. to 7:00 a.m., and from 1:00 p.m. to 5:00 p.m., at some point during which people often feel tired, before their levels pick up again. 

A predictive fatigue risk warning system, such as Predictive Safety’s PRISM fatigue management platform, works by calculating fatigue risk according to several inputs:

• Data points in a Fatigue Risk Index: shift times, lengths, circadian rhythm requirements, etc.
• Employee inputs: questionnaires, # of hours slept, results of the AlertMeter^® test

Measuring sleep habits is important in determining whether a worker is fit for duty. For instance, in the PRISM system, a worker with three or fewer hours’ sleep between shifts would be considered to have a high-risk fatigue status, while three to six hours’ sleep would trigger a warning and require the worker to complete the alertness test. Getting more than six hours’ sleep between shifts is ideal and indicates a fatigue status of “normal.”

When the system detects heightened fatigue risk for an employee, it triggers countermeasures. If the employee doesn't utilize the countermeasures and demonstrate alertness by passing their AlertMeter^® test, a supervisor is notified to assess the situation. 

Fatigue in the workplace is as important as monitoring as drug and alcohol use for three key reasons:

1. Shift workers are always susceptible to fatigue symptoms. Fatigue cannot be eliminated from shift work. 
2. Unlike discretionary drug and alcohol use, proper sleep is not always possible. 
3. Fatigue can affect brain function similar to alcohol intoxication, resulting in impaired judgment and a variety of other cognitive effects and symptoms. This may culminate in a fatigued employee judging his or her own fatigue as less severe than it really is.

Conclusion

A study of Predictive Safety’s PRISM fatigue management system at a South African iron mine showed that monitoring and managing fatigue risk immediately impacted mine employees’ hours worked during high-risk fatigue zones.

Consequently, over the course of the next year, shift attendance improved by about 3%, and incident rates per produced metric ton dropped by about 35%. (6)

Worker feedback: 

• When asked about their experience using the fatigue management system, 84% of workers and supervisors agreed that fatigue risk monitoring increased their awareness of job safety and performance.
• In addition, 80% of workers and supervisors agreed that fatigue risk management increased their ability to manage their own fatigue levels at work.
• Plus, 94% of workers thought that monitoring fatigue risk would help managers and supervisors understand the workforce better and help to improve their working conditions, and
• 96% of workers reported feeling better about their work environment knowing that their co-workers were being monitored for alertness/fatigue. 

Fatigue is Both a Personal and Occupational Risk Factor

It is a complex mental state characterized by a lack of alertness and reduced mental and physical performance often accompanied by drowsiness. It is associated with spending long hours awake, an inadequate amount of sleep over an extended period or an insufficient quality of sleep, high physical and mental loads, and a number of non-work-related factors.

From a practical viewpoint, it is doubtful that fatigue in the workplace can be eliminated altogether, but it certainly can be controlled and mitigated through proper management. 

Fatigue management is a shared responsibility between the organization and its employees, and all stakeholders should participate in order to provide the safest and healthiest working environment possible. To achieve this, a holistic approach based on best practices is required.

More Resources:

6 Reasons Why Your Company Needs to Manage Work Fatigue and Impairment (Part 1)

6 Reasons Why Your Company Needs to Manage Work Fatigue and Impairment (Part 2)

3 Ways Sleep Sleep Apnea at Work is Costing Your Business (And How To Fix It)

6 Fatigue Countermeasures

Predictive Safety Featured On the WorkSAFE Podcast: Tech Designed to Stop Fatigue Impairment Risk in Its Tracks

The Science of Fatigue at Work

Fatigue Risk Management Without Regulatory Guidance

Real-Time Fatigue Monitoring & Management Software

References

Schutte, P.C. (2009). Fatigue risk management: Charting a path to a safer workplace. The Southern African Institute of Mining and Metallurgy, Hard Rock Safe Safety Conference: Sun City, South Africa.

Harrington, J.M. (2001). Health effects of shift work and extended hours of work. Occupational and Environmental Medicine 58(1):68–72.

Van Dongen, H.P.A. & Dinges, D.F. (2005). Sleep, circadian rhythms, and psychomotor vigilance. Clinics in Sports Medicine 24(2): 237–249. doi:10.1016/j.csm.2004.12.007

Caldwell, J.A., Caldwell, J.L., & Schmidt, R.M. (2008). Alertness management strategies for operational contexts. Sleep Medicine Reviews 12(4): 257–273. doi:10.1016/j. smrv.2008.01.002

Quality improvement model. (n.d.). Purdue University. Retrieved from http://www.stat.purdue.edu/~kuczek/stat513/SPC Course Slides/11-Quality Improvement Model.ppt 

Heitmann, A. (2011). Evaluation of fatigue systems. Awake Institute.

Pelders, J., & Nelson, G. (2019). Contributors to Fatigue of Mine Workers in the South African Gold and Platinum Sector. Safety and health at work, 10(2), 188–195. https://doi.org/10.1016/j.shaw.2018.12.002