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We developed and assessed a program designed to help small business owners/managers conduct short training sessions with their employees, involve employees in identifying and addressing workplace hazards, and make workplace changes (including physical and work practice changes) to improve workplace safety.
During 2006, in partnership with a major workers' compensation insurance carrier and a restaurant trade association, university-based trainers conducted workshops for more than 200 restaurant and food service -owners/managers. Workshop participants completed posttests to assess their knowledge, attitudes, and intentions to implement health and safety changes. On-site follow-up interviews with 10 participants were conducted three to six months after the training to assess the extent to which program components were used and worksite changes were made.
Post-training assessments demonstrated that attendees increased their understanding and commitment to health and safety, and felt prepared to provide health and safety training to their employees. Follow-up interviews indicated that participants incorporated core program concepts into their training and supervision practices. Participants conducted training, discussed workplace hazards and solutions with employees, and made changes in the workplace and work practices to improve workers' health and safety.
This program demonstrated that owners of small businesses can adopt a philosophy of employee involvement in their health and safety programs if provided with simple, easy-to-use materials and a training demonstration. Attending a workshop where they can interact with other owners/managers of small restaurants was also a key to the program's success.
The restaurant and food service industry in California employs one million workers, largely low-paid, vulnerable workers, including many immigrant and young workers. Ninety percent of these businesses have fewer than 50 employees (half have fewer than 10 employees)1 and often lack the health and safety information and resources typically available to larger businesses.2,3 In addition, the fast-paced nature of restaurant and food service work and the tight profit margins for many small restaurants pose challenges for integrating effective health and safety training.
In response to this need, the California Commission on Health and Safety and Workers' Compensation (CHSWC) funded the development of a health and safety training program for owners/managers of small restaurants as part of its Worker Occupational Safety and Health Training and Education Program (WOSHTEP). WOSHTEP is administered by CHSWC in the Department of Industrial Relations through interagency agreements with the Labor Occupational Health Program (LOHP) at the University of California, Berkeley (UC Berkeley), and the Labor Occupational Safety and Health Program (LOSH) at the University of California, Los Angeles.
Research has indicated that work culture issues, including management's commitment to and employees' engagement in health and safety, may be more important than training per se in actually preventing injuries.4–6 Yet, previously developed educational tools on restaurant health and safety did not provide employers with specific activities to support this approach.7–9 The focus of the Small Business Restaurant Supervisor Safety Training program was to encourage restaurant owners/managers to train their employees in a way that actively engages them in identifying hazards as well as solutions, and demonstrates management's commitment to making the workplace changes that are identified (including physical and work practice changes).
To develop the program, LOHP reviewed existing materials, held discussions with owners of small restaurants in an informal focus group, field-tested training activities with workers in several restaurants, and pilot-tested a training workshop for managers and supervisors. Feedback from restaurateurs emphasized that training time is very limited; resources must be brief, user-friendly, and adaptable to their own restaurants; and any materials for employees must also be available in Spanish. As a result, the program's materials included a training guide for two short activities that owners/managers could conduct with their employees: (1) a walk-through or hazard-mapping activity to identify hazards in their workplace, and (2) an activity to encourage employees to generate possible solutions for specific problems using hazard-specific tip sheets. The training packet also contained other resources including a model shoe policy, fact sheets on employing teen workers, and an employee orientation checklist. Several of these resources were adapted from the “Teen-worker Restaurant Safety Program” materials developed previously by the Washington State Department of Labor and Industries.9 The entire packet was available in both Spanish and English. The training program for the owners/managers consisted of two hours of interactive training that included a demonstration of the hazard-mapping and tip sheet activities.
During 2006, in partnership with the California State Compensation Insurance Fund and the California Restaurant Association, trainers from LOHP and LOSH conducted 17 two-hour training workshops for more than 200 restaurant and food service owners/managers. The training program was evaluated at the end of the first year of implementation as part of an independent evaluation of WOSHTEP. The goal of the evaluation was to assess the effects of the program and whether it helped small business managers to (1) conduct effective health and safety training for their employees, (2) involve employees in identifying and addressing workplace hazards, and (3) make changes in the physical workplace and work practices to improve workplace safety. The evaluation was modestly funded as part of a service delivery program and not as a formal research activity. Its primary purpose was to inform program stakeholders and provide a basis to decide whether to modify, abolish, or continue the program. This article summarizes the results of the evaluation.
The impact model (Figure 1) illustrates how the program planners considered that change would occur as a result of this program. Program evaluation consisted of two methods: (1) a post-training assessment form with 19 multiple-choice questions and five write-in items to assess the short-term impact of the workshops, such as usefulness of the workshop, knowledge gained, and intentions to implement health and safety procedures at the worksite; and (2) lengthy in-person interviews with owners/managers from participating restaurants three to nine months after they attended the workshop, using a semistructured interview protocol.
Participants also completed a registration form with contact information and 11 questions about the restaurant and owner/manager's prior health and safety experience. The methodology was based on standards achievement: did a high percentage of owners/-managers leave the workshop with knowledge and attitudes that facilitate workplace change and with the skills to provide employee training? Pretests were not used, due to the short time frame for the workshops and the already lengthy registration and posttest forms the participants were asked to complete. Instead, participants were asked to assess their own knowledge gains at posttest; this type of retrospective pre-/posttest has been used with success in other public health programs.10,11
Interviews were conducted using procedures common to good qualitative field research to obtain authentic responses by asking questions that were relevant to the experiences of interviewees, conducting interviews at the owner/manager's worksite during working hours, and conducting lengthy interviews with open-ended questions to obtain rich, thick text.12–14 We did not seek to obtain independent reports from workers in the participating restaurants due to human subjects protection concerns. The Office for the Protection of Human Subjects, UC Berkeley, Committee for Protection of Human Subjects protocol #2006-7-20, reviewed and approved the evaluation procedures.
A total of 213 representatives of 161 small business restaurants or food-provision service organizations attended one of 17 workshops conducted from March through October 2006. The workers' compensation insurer mailed fliers to their restaurant policy holders and, in some cases, followed up with phone calls to invite them to a workshop. The restaurant association posted information about the workshops on their website.
The independent evaluator interviewed 10 owners/managers in December 2006. The highest-ranking attendee from each of the 13 restaurants represented at the March 2006 Bay Area workshop was selected and contacted multiple times, and seven agreed to be interviewed. The sample was augmented by three attendees at the September 2006 workshop in Sacramento. The evaluator conducted the interviews, which ranged in length from 25 minutes to one hour, at the owner/manager's worksite.
Data from the registration forms and post-training assessment forms were entered by CHSWC staff into a database developed and maintained by CHSWC and were provided to the independent evaluator for analysis. The extensive interview notes were reviewed and transferred to a qualitative analysis software package. They were analyzed using a coding guide that was developed a priori, based on research questions developed by the project's evaluation advisory committee; new codes were added during analysis to capture pertinent themes and distinctions.
Of the 213 participants, one-half had no prior health and safety training in the past five years, even though 44% had worked at their restaurant for at least five years. More than half (54%) were motivated to attend the workshop out of concern for health and safety. Attendees were also motivated by the recommendation of their workers' compensation insurer (26%), injuries at their workplace (18%), and high workers' compensation costs (12%). Thirty-nine percent of participating businesses were restaurants with 20 or fewer employees, and 35% were restaurants with more than 20 employees (but fewer than 200). Eighteen percent of the attendees' workplaces were service organizations such as charity dining rooms, elder food programs, or job-training programs. The remaining 8% were other associated businesses such as insurance brokers or staffing agencies. Figure 2 details the size of participating businesses, when restaurants and food service organizations were combined.
Based on the posttests collected at the end of the workshops, attendees overwhelmingly found the workshop's content and key ideas (92%) and tip sheets (95%) to be useful. As many as two-thirds (66%) learned how to identify health and safety hazards, and improve employee work practices. Almost three-quarters (74%) felt they had learned how to conduct interactive training activities. By the end of the workshop, almost all (98%) believed that their employees would have practical ideas about how to improve workplace safety, but far fewer (13%) accepted that it is sometimes more cost-effective to make physical changes to the workplace than to train employees to be more careful. More than two-thirds (69%) reported that they were very likely to provide an hour-long training session to staff. Results for most items are summarized in Table 1–4.
Although almost half of the attendees came to the workshop already in possession of health and safety information (43% had attended other health and safety trainings in the past five years), most reported learning a great deal at the workshop (Table 2). By the end of the workshop, many attendees possessed attitudes that would enable them to make workplace changes (Table 3). Additionally, by the end of the workshop, most attendees felt ready to implement health and safety activities (Table 4).
On-site follow-up interviews conducted to assess the program's actual impact showed that participating owners/managers took action upon returning to their worksites.
All owners/managers interviewed had shared the information gained from the workshop with the owner, other managers, or employees. They did this by speaking with groups of managers or with the restaurant's safety committee, talking to workers on the floor, and/or posting the tip sheets in an area common to all workers.
Owners/managers described specific activities they undertook, in addition to simply sharing the information. These activities included holding special meetings with employees to discuss hazards, and pointing out specific hazards in the proximal work area in one-on-one conversations with employees. Overall, these owners/managers embodied the notion of bottom-up hazard identification by encouraging the employees to identify the hazards and propose solutions.
For example, at a larger restaurant, a safety committee was reinstituted to identify hazards and make recommendations. The safety committee brought several ideas to management, which were implemented. As the manager noted, “We revived the safety committee. It [comprises] one person from each department—bussers, servers, cooks.… This works better. They see more than we do. Instead of them complaining, they solve the issue and they follow through.”
At a small bar/restaurant, the owner spoke with a day-shift employee about the risks of wine glasses breaking during sink-washing. Together, they worked backward to realize that the late-evening shift put cracked glasses on the shelf because the light was too dim to see the damage.
Eight of the 10 owners/managers interviewed conducted a walk-through inspection together with employees after attending the workshop. Three of the 10 interviewees stated that they and their employees drew a hazard-identification map, as demonstrated at the workshop.
Nine of the 10 interviewees said that they or other managers had trained employees since attending the workshop. Two restaurants conducted a training session similar to the one demonstrated at the workshop. One told us, “Yes, I have them draw a map. We really do it the way they showed in the seminar.” Others continued the type of training their restaurant had offered in the past, but incorporated the interactive training techniques and materials offered at the workshop.
“I do training one to two times a year,” noted the human resources manager from a larger restaurant with several locations. “I have incorporated the kit from the seminar and the information into the training. Plus, I stress more of these things with the managers.… I'll continue to use these materials.”
Six of the 10 interviewees discussed changes that were made to workplace policies and practices after attending the workshop. Two restaurants developed or revised policies about robberies, and one discussed changes in procedures for carrying cash drawers. One developed a safety manual, another reinforced that people younger than 18 years of age could not use certain equipment, and another established designated areas for specific tasks, such as cutting raw meat.
Four owners/managers added small equipment, such as special chairs for those who stand, “slippery floor” signs, and rubber mats. Two purchased personal protective equipment, cutting gloves, and belts. And two made changes to the physical space by changing light fixtures and moving freezer boxes that were in the way.
“One of the things we fixed right away was to move the two cold boxes behind the bar to make them even to prevent people from hitting their thigh against the one that sticks out,” noted the owner of a smaller bar/restaurant. “Secondly, we got a doorman on Saturday nights to attend the door and keep peace in the parking yard.”
Three owners/managers did not make physical changes to the workplace because they did not feel these were warranted. One said, “We haven't made physical changes because we have had a clean bill of health twice in a row.” Another reported, “All our cleaning products are stored properly, and we already have mats, so there is not much to change physically.”
Three of those interviewed discussed how difficult it is to make these changes, especially if the expense is high. One described foot-tall electrical posts that stick up out of the floor: “They are right under the sandwich board, which is a problem. It would be financially impossible to fix our problem.” Another manager described slipping problems exacerbated by an old floor.
During the interviews, participants were also asked what they thought of the workshop in retrospect. The owners/managers found the information presented at the workshop to be useful, even those who were experienced in restaurant work. Five of the owners/managers commented on the usefulness of attending a training workshop in person rather than receiving materials in the mail, even though it was difficult for some to get away from work and attend the workshop. “It's better to go to a seminar than just get the materials,” noted one manager. “It is interesting to hear others and how they do it. I couldn't get that from just reading.” All but one owner/manager thought that the small group interaction was an excellent part of the workshop. They reported that these interactions built camaraderie and allowed owners/managers from different restaurants to share common problems and receive suggestions from one another.
Reaching small business owners is very challenging. It is heartening that the program reached owners/managers of even very small businesses. Partnering with a workers' compensation insurer, which hosted all of the workshops and did most of the recruiting, was a key component in successful recruitment for the workshops. The workers' compensation insurer and CHSWC were both sufficiently satisfied with the workshops' success to continue the program and offer additional workshops.
In both the post-training assessments and the follow-up interviews, participants indicated that one of the most valuable aspects of the workshop was the opportunity to discuss problems and solutions with other owners/managers of small restaurants or food service programs. This not only successfully modeled the interactive approach, but also appeared to increase participants' sense of self-confidence and motivation to go back to their worksites and make improvements. Although this was an intended effect of the interactive training, participants seemed sufficiently surprised and gratified by this component that it should be highlighted in future outreach efforts.
The primary goal of this workshop was to prepare and inspire owners/managers to go back to their workplaces and teach their employees health and safety information and skills, using interactive training techniques. The workshop activities were intended to provide owners/managers with an approach to safety that embraces the concept that workplace injuries and illnesses will be reduced if employees participate in identifying hazards and solving workplace problems, and if management commits to implementing feasible solutions. To a large extent, this goal was achieved. Post-training assessments indicated that two-thirds left the workshop feeling very prepared to conduct the two short employee training activities that were demonstrated. The follow-up interviews indicated that although few owners/managers were conducting the two training activities exactly as demonstrated and as described in the training guide, almost all have adopted a “bottom-up” philosophy of hazard identification and solution proposals, actively engaging their employees, and have used elements of the hazard-mapping exercise in discussions or training. Most have also revised their workplace health and safety policies and training materials. Many have purchased equipment such as floor mats, hot mitts, and stickers for slicing machines that prohibit use by minors.
The evaluation findings also indicated that attending a training workshop rather than just receiving the materials was a key element affecting participants' decisions to make changes in the workplace. Because training is more costly and time-consuming than simply mailing out materials, further evaluation efforts might be useful, focusing on comparing the relative effectiveness of only providing training materials vs. attending a training workshop.
A core message in the workshop, as well as in the training guide, was that making physical changes in the workplace, when at all possible, is ultimately more cost-effective than having to rely on training or protective equipment to protect employees from hazards. However, both the post-training assessments and the follow-up interviews indicated that most participants did not adopt this belief. Hazards such as swing doors between the kitchen and dining room, low places on the floor where water can create a puddle, and structural tripping hazards were discussed in the follow-up interviews as issues for training and caution, rather than for remediation. These responses indicated that the workshop was more successful in promoting training to engage employees, and less successful in convincing owners to invest in workplace changes. Owners/managers, especially of restaurants with 20 or fewer employees, believed that remediation of physical hazards was not feasible in most cases. One way to address this might be to add to the workshop more specific examples of different engineering controls or other physical changes that owners of small restaurants have successfully made, along with the costs of these changes.
As noted previously, resources were not available for a case-control study that would more rigorously assess the impact of this training program. However, integrating even a modest evaluation into a service delivery program is an important first step for program stakeholders and provides valuable information to guide the development of this and other programs. Key limitations of this study included the lack of a comparison group, selection bias (those who chose to attend may have been more motivated to improve workplace health and safety than those who were invited but did not attend), the small sample number for the interviews, and the lack of multiple perspectives (findings may have been limited by reliance on only one source of information: the owners/managers). The use of a thoughtfully designed theory-of-change model (impact model), the high response rate for the posttests and interviews, the use of mixed methods with structured protocols, measures taken over time, and implementation by an independent evaluator together reduced potential threats to the validity and made the findings presented in this article credible, despite the lack of a control group.
This evaluation demonstrated that providing short, interactive health and safety workshops and easy-to-use training materials to owners/managers of small restaurants can lead to improvements in the workplace. Although in many cases participants did not use the training materials exactly as designed, participating owners/managers did appear to adopt a philosophy of employee involvement in their health and safety programs and demonstrated this by conducting training for employees, discussing workplace hazards and solutions with employees, and, in some cases, making changes in the workplace or in work practices to improve workers' health and safety. These results suggest that this model should be disseminated more broadly. This will pose significant challenges, however, given that restaurant owners are typically hard to reach and have little time to attend training. Building a collaborative effort involving business associations and insurance carriers appears to be a promising approach for meeting this challenge.