Disability management reduces costs and lost time
Disability management reduces costs and lost time
Workers' compensation claims cut by 33%
By Lynda Wilson-Hare, BScHK, CRSP
Occupational Health And Safety Team Lead
Grand River Hospital
Kitchener, Ontario, Canada
Hospital workplaces today are prone to re-engineering, downsizing, and cost-recovery programs that tend to impact disability management efforts by increasing employee stress levels, leading to greater injury and illness rates. At times like this, it is imperative to have programs in place to support staff and decrease their time away from work. In 1996, a revitalization program was implemented at the Freeport site of Grand River Hospital in Kitchener, Ontario, to enhance our disability management.
The program proved to be successful, saving $92,865 in decreased time away from work; cutting workers' compensation claims by 33%; reducing average days on a modified work program from 24.3 per person in 1995 to 15.6 per person in 1996, and then to 12.9 per person in 1997; and minimizing the potential for injury recurrence. This was exemplified by the fact that in 1996, eight workers participating in modified duty programs in 1995 had to be re-enrolled due to repeat injuries, but in 1997 only six were re-enrolled from the previous year.
Too much time spent on modified duty
In 1995, Freeport Hospital merged with Kitchener-Waterloo Hospital to form the Grand River Hospital Corporation. In January 1996, the occupational health and safety departments completed their merger and began sharing services for 2,600 employees at two sites. Freeport Hospital had an effective claims management and modified work program; however, the length of time on modified duty was usually eight to 20 weeks. No physiotherapy or occupational therapy program was available on-site for employees. In addition, many employees were having recurring injuries because initial injuries were not treated effectively. On the other hand, the Kitchener-Waterloo (KW) site had a physiotherapist and an occupational therapist on staff for employees, which had been very effective.
Intervention reduces modified-duty days
When the KW occupational health and safety team first decided to offer services to the Freeport site employees, we hypothesized that as treatment started, we would see a larger number of staff enroll in modified work initially. Many staff were working full duties but with a significant amount of pain. When they received treatment, therapists placed them on modified work so their therapy would be more effective. Secondly, many staff off work on sick leave were not receiving therapy at all, but could benefit from treatment and even be able to increase activity to perform modified work. After a short period of time, we expected the number of staff on modified work to decrease as they improved physical strength due to work hardening without cause for future injury. This intervention also reduces the number of days employees are on modified work because as they increase physical tolerances, we can place them back on their pre-injury jobs much more quickly.
The revitalization team, a rehabilitation component of the occupational health and safety department, consists of an employee health nurse who manages the modified work program and meets regularly with the physiotherapist and occupational therapist. Team responsibilities also include providing education (departmental, individual and all staff sessions), ergonomics (job site assessments, work processes, education), work hardening, functional abilities testing, job matching, splinting (for carpal tunnel syndrome and tendinitis), physical therapy, and exercise programs.
Employees enrolled with the team are asked to sign a consent for regular progress reports to be sent to their family physician. This keeps employees' family physicians current with work-hardening plans and aware of when employees are ready to perform full duties, rather than waiting for employees to tell their doctors when they are fit for work.
The work-hardening program consists of utilizing the work simulator (a device that simulates equipment movements and weights at interchangeable levels), job site analyses (physical demands and ergonomic assessments), re-instruction, and gradual increases in workers' job tasks to the level of pre-injury duties.
All revitalization team services are free of charge to employees. As a result, neither insurance companies nor workers' compensation pays for worker's physical therapy, thus saving money. Employees do not miss as much time from work when therapy is provided on site. They are more likely to keep appointments that are part of their work schedule. As a proactive measure, emergency appointments can be scheduled for employees who have just sustained an injury or who have muscle tension resulting in neck strain or headaches, preventing lost time from work.
Team familiar with job demands
The revitalization team also provides functional ability evaluations (FAE), which are crucial for returning disabled employees to the work force with suitable jobs. The FAE also has been used for pre-placement screenings and when disabled workers have been bumped out of their accommodated jobs due to layoffs. The team is well-versed in all jobs within the hospital through physical demands assessments. This is beneficial for testing purposes, work hardening, and job matching.
Implementation of the revitalization team's proactive interventions significantly reduced workers' compensation claims for musculoskeletal injuries from 36 claims in 1995 to 12 in 1997. As hypothesized, introduction of the team in 1996 created a greater number of employees on modified work (147), which was greatly reduced by 1997 (47). (See charts, p. 100.)
In addition to the revitalization team's efforts, the occupational health and safety department became proactive in encouraging employees to report incidents, unsafe situations, and complaints of pain. This information is recorded on the Ontario Hospital Association's employee incident reports for all of those work-related conditions, even if they do not result in workers' compensation claims. The occupational health and safety assistant performs follow-up and investigates all incidents to ensure proper corrections and referrals.
[Editor's note: For more information on the Grand River Hospital disability management program, contact Lynda Wilson-Hare at (519) 894-8360, ext. 3742.]
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