Chevron Adopts Biopsychosocial Model to Address Repetitive Stress Injury

Chevron has a strong history of addressing injury prevention and employee health for its employees. When management detected a surprising injury increase in office workers in 2000, however, they knew that a new approach was in order.

The solution, a prevention-based process called “Repetitive Stress Injury Prevention Program,” takes advantage of Chevron’s integration of Health & Productivity Services, managed by Tanya Lughermo, with its Employee Assistance and WorkLife Program (EAP/WorkLife), under Lee Sparling.

“Having EAP/WorkLife as part of our health team,” said Lughermo, “allows us to look at the psychosocial issues that impact health and lifestyle behavior change from the ground up.” Sparling credits Chevron’s long-standing incorporation of an internal EAP staff and an emphasis on investing in people for EAP/WorkLife’s ability to work with others and be more proactive in meeting the behavioral and health needs of Chevron’s workforce.

Preventing Common Office Injuries

The type of injury Chevron and many other employers have seen increasing is repetitive stress injury (RSI). Repetitive stress injury (RSI) is an umbrella term for disorders that develop from repetitive movements, awkward postures, sustained force, and other risk factors. RSI has become more prominent in recent years with the rise in computer use. It is also referred to as carpal tunnel syndrome, cumulative trauma disorder, and work-related upper limb disorder.

To reduce physical strain, Lughermo, an occupational therapist, designed an approach for employees at high risk that promotes a “rapid response” to discomfort. The Rapid Response Team implements an ergonomic assessment and intervention, including an adjustment of workstations, equipment, and work processes, such as workload or job rotation.

Supervisors and employees also receive education in prevention. A clinical assessment identifies workers who may need additional medical evaluation and treatment. Other recommendations made on an individual basis may include stretching, job-specific conditioning, and changes in work behaviors and postures.

Senior management, with the support of Chevron’s Chairman and CEO David J. O’Reilly, asked all business units to address the rising incidence of RSIs.

Behavioral Factors

Although the ergonomic solutions and physical conditioning of the program's Rapid Response Team have been effective for many employees and RSI cases have significantly decreased, Lughermo discovered that several groups of employees present a particular challenge to program staff. The common denominator in these groups seems to be more psychosocial and behavioral than biomedical.

Furthermore, many pain experts now embrace a biopsychosocial model of pain, acknowledging the complex interaction between biological, cognitive, emotional, behavioral and social factors in the perception of and response to pain.

“Super Workers”

Workers who ignore or deny early warning signs of discomfort are one example of a group that presents a challenge to staff. These employees, “super workers,” push through to meet project deadlines or to complete work-related travel and place undue emotional and physical strains on themselves. They try not to draw attention to themselves, to complain, or to use company resources unnecessarily. However, by not making their health a priority, super workers do use resources eventually when the discomfort moves to considerable pain and they are unable to complete work tasks effectively.

The goal with these workers is to keep educational information in front of them and to alert managers to the issue, making them aware of the business impact of such practices.

International Employees

Another challenging group is the approximately 1,300 U.S. employees working outside the United States. These employees face significant challenges in the long stretches of travel they must endure and unpredictable changes in their lifestyle. Lughermo and Sparling, along with their colleagues in occupational medicine and in the HR cultural training group, have a proactive approach for international employees as well as their spouses, providing information about coping with living abroad and helping them prepare emotionally and physically for their adjustment.

Employees with Personal Problems

Employees with major stressors at work and home represent another challenge. Their problems can include relationship difficulties, most frequently with supervisors, children, or spouses. They may be out of condition physically, overweight, or single parents, sometimes with self-esteem difficulties and ineffective coping strategies.

Lughermo recognizes the many psychosocial and behavior change issues this group faces. She is working with Sparling in this area so that the Rapid Response Team can make earlier referrals to appropriate EAP staff or elsewhere. By identifying appropriate support measures and encouraging follow-through, the team may be able to maintain the employee’s work performance.

Early Detection

As one of its strategies to identify psychosocial risk factors early, Chevron added mental health and coping strategy questions to its health risk appraisals (HRAs). Employees are encouraged to complete the HRAs at least yearly to assess lifestyle habits and identify health conditions early for prevention and proactive treatment.

Behavioral health questions are also a part of Chevron’s disease management programs for individuals with chronic conditions like coronary artery disease and diabetes. Early identification of co-occurring depression and rapid referral to the EAP has been built into these programs for a seamless approach.

A new cardiovascular health program, to be launched globally in 2008, will also reflect the strong integration of behavioral and physical health. Lughermo and Sparling recognize the strong contribution of depression and stress to cardiovascular disease and are building in systems for identification and concurrent treatment.

As an internal EAP with eight full-time staff members, Sparling and her team frequently consult with management and create customized supervisor training to proactively identify needs for site-specific stress and change management interventions.

Behavioral Health Benefits

Chevron’s carve-out mental health/substance abuse plan, available to all employees, encourages appropriate access to care. There are no deductibles, and coverage for outpatient visits is 90%. Inpatient costs are covered at 80%.

Access to psychiatrists and other providers is available through the EAP/WorkLife advisors or directly through the insurance provider. This plan also provides coverage for life event concerns and transitions, such as relationship counseling, occupational concerns, and phase-of-life issues.

Next Steps

Future plans for the Rapid Response Team include the following:

• Developing a checklist of potential psychosocial problems for ergonomic specialists to use as they evaluate physical aspects of employee workstations.

• Developing mentoring relationships between workstation evaluators and EAP staff to encourage referral to the EAP when psychosocial problems are identified.

• Training all team members in the behavior-change cycle so that intervention strategies can be matched to an employee’s readiness to change.

Advantages of an Internal Staff

The long-time involvement of an internal EAP and health promotion staff is a significant advantage in meeting these challenges. These managers know the culture of the organization and are able to talk from the business perspective.

“You don’t see that with outside vendors,” says Lughermo. “Knowing the business drivers, such as safety priorities, the strategic plan, people strategy, recruitment goals, and new business processes, allows us to help other managers with their day-to-day business priorities.”

“Safety and health moments” at Chevron are brief educational presentations delivered at the start of meetings. These health moments demonstrate the priority placed on employee well-being and mutual responsibility. Examples include ideas for addressing sleep problems, strategies for safe lifting, and breathing techniques to enhance relaxation at workstations.

The fact that all regular business meetings begin with a “safety and health moment” demonstrates the emphasis employee well-being receives from the Chairman on down the ladder.

Chevron places a high priority on physical and psychosocial health. Integrating departments and building alliances for early identification and appropriate treatment of physical and mental health helps Chevron walk the talk.

About Chevron

Chevron is one of the largest integrated energy companies in the world, conducting business in approximately 180 countries. The company employs around 56,000 individuals, excluding about 6,600 service station employees.

Nancy Spangler, PhD, OTR/L is a consultant to the Partnership for Workplace Mental Health and the American Psychiatric Association Foundation.​

Last Updated: July 2007