DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

Contents

▶ Prevention through Design 1

▶ Methods of the NIOSH Study: 

Determining Reasons for PtD 

Adoption 2

▶ Case 1 2

▶ Case 2 2

▶ Case 3 3

▶ Conclusions 3

▶ Recommendations 3

▶ Acknowledgments 3

▶ References 3

▶ Suggested Citation 4

Prevention through 

Design (PtD)

PtD addresses worker exposure to 

hazards during the design stages of 

a project. One of the best ways to 

prevent and control occupational 

injuries, illnesses, and fatalities 

is to “design out” or minimize 

hazards and risks. NIOSH leads a 

national initiative called Prevention through Design (PtD). PtD’s 

purpose is to promote this concept 

and highlight its importance in 

all business decisions. For more 

information, see http://www.cdc.

gov/niosh/topics/ptd/ 

Supporting Prevention 

through Design (PtD) Using 

Business Value Concepts

Prevention through 

Design

Prevention through Design (PtD) can 

be defined as anticipating and designing out or eliminating safety and health 

hazards in facilities, work methods 

and operations, processes, equipment, 

tools, products, new technologies, 

and the organization of work [NIOSH 

2013]. PtD concepts include all prevention considerations in the design, redesign, and retrofit of new and existing 

tools, equipment, structures, and work 

processes to reduce or prevent occupational injuries, illnesses, and fatalities 

[NIOSH 2010]. Unique to PtD concepts is the focus on workers who execute the designs or have to work with 

the products of the design, redesign, 

or retrofit [NIOSH 2014a]. It has been 

well documented that using PtD design 

concepts or principles is the most effective and reliable type of prevention 

(see NIOSH PtD website; http://www.

cdc.gov/niosh/topics/PTD/). Furthermore, when examined using concepts 

of a business case (which captures the 

reasoning for initiating or continuing 

a project or task), PtD solutions have 

been shown to be good business decisions, whether the analysis includes 

financial or non-financial measures.*

[AIHA 2009; Occidental College 2002].

The National Institute for Occupational 

Safety and Health (NIOSH) launched a 

PtD initiative in 2007 with the purpose 

of encouraging the inclusion of prevention considerations in all designs 

that affect workers. As the NIOSH PtD 

initiative progressed, it was found that 

many promising engineering design 

solutions (those grounded in PtD 

principles) were not being transferred 

from research into practice. The failure 

to implement known effective solutions 

suggested that occupational safety and 

health (OSH) decisions may be based 

on other benefits beyond the usual goal 

of injury reduction or cost savings. 

Understanding the reasons businesses 

use programs and practices grounded in 

PtD became the objective of a NIOSH 

study. Identifying the different benefits 

of adopting PtD design solutions can 

help companies better appreciate and 

integrate PtD principles into their overall safety management systems. 

This document highlights some ways 

that employers make decisions concern-

*For more information about implementing 

and promoting PtD solutions, see Renshaw [2013] and Toole et al. [2013].
2

ing PtD solutions that are known to reduce 

injuries and illnesses so that readers will 

better understand how to encourage the 

use (or implementation) of PtD solutions. 

It is not an economic evaluation of these 

solutions nor a comprehensive business 

case analysis, but presents the reasoning 

used by a select number of employers for 

adopting PtD solutions. Furthermore, it 

shows that there may be different types 

of adoption criteria such as outcome 

measures that use a dollar basis (financial 

measures) and those using a non-dollar 

basis (non-financial measures). 

This document presents some of the 

reasons that companies have adopted PtD 

design solutions captured in prior research studies through interviews of those 

involved in adopting the specific solutions. 

Although not all business case steps were 

examined, the reasons for adoption can 

be found in the eight steps of the AIHA 

[2010] Value Strategy or CDC [2009] Business Case Guidelines. If safety and health 

practitioners employed all steps as they explore solutions to problems found in their 

worksite, it is more likely that they could 

justify the resources necessary to adopt the 

PtD solution of interest. 

Methods of the NIOSH 

Study: Determining 

Reasons for PtD 

Adoption

For this NIOSH study, three PtD engineering design solutions were selected 

that represented unique work processes 

in different industries [Biddle 2013]. To 

determine what may have prompted these 

companies to adopt the PtD solutions, the 

study reviewed prior research findings and 

interviewed workers and those who were 

responsible for safety and health programs. 

The study examined the application of selected components of a traditional business 

case to determine the anticipated or known 

effects that a decision can have on the 

financial and non-financial performance of 

a company. 

To determine the reasons for adopting or 

not adopting PtD solutions, the research 

team used the American Industrial Hygiene 

Association (AIHA) Value Strategy [AIHA 

2009], which is largely based on the Centers 

for Disease Control and Prevention (CDC) 

Business Case Resource Guide [CDC 2009]. 

The Value Strategy is a process that explores 

organizational objectives and priorities that 

can be used by decision makers to allocate 

resources in the organization. For example, 

the Value Strategy would include the financial benefits arising from a reduction in occupational injury and illness expenses or an 

increase in production levels. Alternatively, 

the Value Strategy would include benefits, such as changes in employee morale, 

company reputation, or employee turnover 

where the changes are not presented in 

dollars and hence are non-financial benefits. 

The Value Strategy is a common method for 

developing a business case for engineering 

solutions in the business community. As a 

result, the business case concepts (as defined 

in the Value Strategy process) were used to 

help identify reasons for their decisions. The 

eight steps of this process used in the study 

can be summarized as follows [AIHA 2009]: 

1. Identify key business objectives and 

hazards

2. Prioritize value opportunities (How 

does the intervention influence business 

objectives?)

3. Assess risk reduction

4. Select approach for the business case

5. Identify changes in health status, risk 

management process, and business 

process

6. Assess the effects of those changes in 

financial and/or non-financial terms

7. Determine the overall value of the PtD 

design solution

8. Present the value of the solution to the 

company (the Value Proposition)

The example case studies below describe 

decisions that led to the adoption of each 

PtD engineering design solution, as well 

as the effects of the implementation of the 

PtD solution:

Case 1

Engineering and administrative controls 

for patient lifting were implemented in six 

nursing homes of a healthcare corporation as part of a best practices program 

to reduce the rate, severity, and associated costs of musculoskeletal disorders. 

The program included mechanical lifting 

equipment, written policies on safe lifting, 

worker training, staff input, and support 

from management and peers [Collins and 

Bell 2010]. 

After implementing the solution, the number of nonfatal injuries dropped from an 

average of 47 per year to 16 per year. Workers’ compensation costs were also greatly 

reduced. The annual average reduction was 

$140,000.

The company had made the decision to 

invest in this safe patient lifting program 

solely on the basis of improving worker 

health outcomes and reducing workers’ 

compensation costs. The company did not 

require any additional cost-benefit analysis to appreciate the economic viability 

of adopting this solution [Biddle 2013; Collins et al. 2004; Collins and Bell 2010]. 

Case 2

An ergonomic analysis of the wine grape 

harvesting industry in Northern California 

conducted by the University of California 

Davis and funded by NIOSH revealed 

substantial risk of overexertion injuries. 

The main factors for these injuries were 

lifting, carrying, and wielding tubs used to 

collect and transport wine grapes as they 

were harvested. As the result of recommendations from this initial study, several wine 

grape harvesting firms adopted a smaller 

tub that reduced each load by 11 pounds 

[Myers et al. 1998]. 

A second study conducted by NIOSH 

nearly 10 years later derived business cases 

for wine grape harvesting firms that had 

adopted the smaller tubs. Interviews with 

managers revealed that the most important 

outcome associated with this design solution was meeting the business objective of 

improving worker morale in this physically demanding hand-harvest process. 

Workers indicated that the smaller tub was 

preferred, as they experienced less fatigue 

and fewer aches and pains. Managers indicated that this improvement was a major 
3

factor in workers’ decisions to remain 

with the company for longer periods, thus 

eliminating the need for finding, hiring, 

or retraining workers with the unique skill 

sets necessary to maintain production 

goals. Meeting these business objectives 

also eliminated the need for management 

to determine the precise financial impact 

of this benefit. The managers who were 

interviewed were not aware of whether the 

specific changes in injury rates were due to 

the smaller tubs and seemed to think that 

the additional cost of $1,000 per year for 

the new tubs was inconsequential [Biddle 

2013; Durai et al. 2000]. 

Case 3

The chemicals used in dry cleaning processes in the garment cleaning industry 

have long been recognized as contributing to ozone depletion and environmental 

pollution. Perchloroethylene (or PERC), 

the most commonly used solvent in the dry 

cleaning process, presents serious health 

risks to workers as it can have respiratory 

and dermal effects, as well as effects on the 

liver, kidneys, and nervous system [EPA 

1993; Ellenbecker and Geiser 2011; NIOSH 

1997]. Efforts have been undertaken 

by EPA and several other organizations 

(Center for Neighborhood Technology, 

Pollution Prevention Center, Toxics Use 

Reduction Institute) to help the dry cleaning industry try alternative processes and 

chemicals for garment cleaning. Results 

were compiled to provide insight into the 

business case for implementing wet cleaning, a water- rather than solvent-based 

process. The benefit of eliminating worker 

exposure to hazardous chemicals in the 

cleaning process was evaluated by comparing the costs of dry methods (PERC-based) 

with those using wet cleaning chemicals. 

Wet cleaning processes proved to be a 

better financial option based on initial 

investment in equipment and operating expenses, such as energy expenses, 

detergent, and machine maintenance, 

when compared with all other potential 

chemical substitutes. Given the reduction 

in exposure to toxic chemicals, it can be 

expected that the number of occupational 

illnesses would decline. Companies could 

have picked another “dry” chemical to 

meet the new regulations, but many chose 

“wet” not only because it was less expensive to operate, but because it afforded the 

companies a claim to social responsibility 

by introducing “green” solutions. As such, 

companies were able to market the wetcleaning process as a “green” solution and 

present themselves as firms who truly care 

about the environment, which can increase 

their share of garment cleaning customers [Biddle 2013, Occidental College 2008; 

Sinsheimer et al. 2004].

Conclusions

The NIOSH PtD study showed that 

companies can have very different reasons 

for adopting a PtD engineering design 

solution. When a PtD solution is being 

considered for use, all possible benefits, 

both financial and non-financial, should 

be explored and included in the business 

case analysis. Reasons for making business 

decisions at individual companies need to 

be understood and addressed to ensure 

that effective PtD solutions are adopted 

and that PtD principles are integrated into 

the overall occupational safety and health 

management system. 

Recommendations

Safety and health professionals at all levels 

and positions in the organization should 

do the following to promote adoption of 

PtD design solutions [AIHA 2009; AIHA 

2010; Biddle et al. 2011]: 

▶ Understand and align PtD solution strategies with the company’s strategic business 

objectives, core mission, and goals. 

▶ Solicit input from the company’s safety 

and health management chain about 

their decision making techniques. 

▶ Identify and seek support from key decision makers who are responsible for (or 

can influence the adoption of) the PtD 

solution. 

▶ Secure the support of senior management for adopting the PtD solution.

▶ Derive and present the business case, 

including financial and non-financial 

benefits of the design solution alongside 

the more commonly conducted risk 

assessment to demonstrate the benefit 

of the PtD solution to the company. For 

more information see the CDC Business Case Resource Guide and the AIHA 

Value Strategy Manual

Acknowledgments

This document was prepared by Elyce 

Biddle, West Virginia University, and Susan 

Afanuh of NIOSH.

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August 2015 DHHS (NIOSH) Publication No. 2015-198

Safer • Healthier • PeopleTM

The information in this document is based on research related 

to Prevention through Design (PtD) initiatives. The complete 

study, along with other PtD articles, can be found in Biddle E 

[2013]. Business cases supporting PtD solutions. Professional 

Safety March:56‒64. 

More information about PtD is available on the NIOSH website at http://www.cdc.gov/niosh/topics/PtD/

To obtain information about other occupational safety and 

health topics, contact NIOSH at:

Telephone: 1–800–CDC–INFO (1–800–232–4636)

TTY: 1–888–232–6348 • CDC INFO: www.cdc.gov/info

or visit the NIOSH website at www.cdc.gov/niosh

For a monthly update on news at NIOSH, subscribe to 

NIOSH eNews by visiting www.cdc.gov/niosh/eNews. 

Mention of any company or product does not constitute 

endorsement by NIOSH. In addition, citations to websites 

external to NIOSH do not constitute NIOSH endorsement 

of the sponsing organizations or their programs or products. 

Furthermore, NIOSH is not responsible for the content of 

these websites.

This document is in the public domain and may be 

freely copied or reprinted. NIOSH encourages all readers of the Workplace Design Solutions to make them 

available to all interested employers and workers.

As part of the Centers for Disease Control and Prevention, 

NIOSH is the Federal agency responsible for conducting research and making recommendations to prevent work-related 

illness and injuries.

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Suggested Citation 

NIOSH [2015]. NIOSH Workplace Design Solutions: supporting Prevention through Design (PtD) using business value concepts. By 

Biddle E, Afanuh S. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 

National Institute for Occupational Safety and Health. DHHS (NIOSH) Publication No. 2015-198.