Using tight controls means a safer workplace
Gaps in the system are costing you money: the injury that isn’t reported right away; the employee who doesn’t keep a doctor’s appointment; and the supervisor who doesn’t make an effort to find a position for an employee with temporary restrictions. By fixing the gaps and adding accountability through an injury management system, Winona (MN) Health reduced workers’ compensation costs from $231,000 to $56,000 in one year alone. And that is just one example of how companies can improve their care of injured workers — and their bottom line.
“There’s kind of a knowledge gap,” explains Cheryl Brennan, RN, MA, loss control supervisor with Berkley Risk Administrators in Minneapolis, who consulted with Winona Health, which has a hospital, long-term care facility, physician clinic, assisted living, home care, and hospice. “If everybody knows and understands what their role is and what they’re accountable for, everything starts working smoothly. You can have very immediate results with this [injury management] program,” she adds.
At Winona Health, injury management is entwined with an effort to improve the safety culture. For example, the health system recently added lift equipment and trained employees on the use of the equipment.
The health system also added personnel to the employee health department by increasing the employee health nurse to a full-time position and adding an occupational therapist with expertise in ergonomics.
The occupational therapist observes employees as they’re using the lift equipment and provides on-site training, says William Gould, SPHR, chief people resources officer. “I think it plays a key role in how we’re managing the injuries and how we’re getting people back to work.”
But the changes at Winona Health went far beyond a boost in the employee health department. The health system rewrote policies and emphasized accountability at every level. “If you’re going to do this, you really need to dedicate the necessary resources to do it well,” says Gould. “It takes a tremendous amount of work to get these processes and policies set up, and then you have to dedicate resources to keep it going.
“It can’t be a matter of your employee health or safety department taking over the process. It has to be owned by the managers and supervisors,” he says.
The payoff is well worth it, says Gould. The health system had fewer reportable injuries (a 30% reduction in the OSHA incident rate) and fewer serious injuries (a 75% reduction in the lost workday rate). Employees also feel more valued when their employee makes their safety a priority, he says.
“As an employer, you have to say, ‘We care about you,’” says Brennan, who developed the injury management program with senior claim examiner Michelle Dressler. “All the way along the pathway, there are opportunities to intervene, to make this go better for the employee.”
Here are some other basic steps in injury management, according to Gould and Brennan:
• Revamp your policies and procedures.
Gould set up a work injury management team made up of a physical therapist, occupational therapist with ergonomics training, employee health nurse, and managers of high-risk areas experiencing a lot of workers’ compensation claims. The team met every other week and reviewed cases as it developed new policies, procedures and training. For example, each job now has a detailed physical requirements assessment.
Job descriptions also need to be revamped to include accountability for safety practices and injury management, Brennan notes. For example, employees have the responsibility to report injuries immediately, keep appointments for doctors and therapists, and comply with restrictions if they’re injured. Supervisors need to report injuries promptly, follow up with employees who are out of work, and notify managers if the injured employee doesn’t show up to an alternate duty shift.
• Designate personnel to handle injury management.
Good injury management requires time and focus. It means calling an employee to find out how a doctor’s appointment went. It means checking up on whether a transitional duty job is working out. It means finding out if pain is being managed properly and whether the employee is having any new medical problems. “It really does take a dedication of resources,” Brennan notes. “The very front end of it is labor-intensive — looking at new policies and procedures, and looking at new training. I think a lot of times, it’s going to take more resources than people are currently dedicating to managing this.”
• Hold people accountable at every level.
Brennan recalls one case in which an employee reported an injury to a nurse manager. The nurse manager let the report sit on her desk for two weeks without notifying anyone. The insurance company and state department of labor received late reports.
That type of behavior could have serious repercussions and should be treated accordingly with disciplinary action, she says. “The employees might not be getting the appropriate medical care they need. If they’re off work and no one knows about it, they might not be getting their benefits.”
Brennan developed forms that incorporate accountability. For example, injured workers sign a form indicating they understand their responsibilities (such as keeping scheduled appointments and obtaining a Report of Work Ability from the physician at least once every two weeks) and will comply with them. The Work Ability/Return to Work form asks if work restrictions apply to the home environment. If not, the physician is asked to explain why. “This is a point of leverage,” adds Brennan, who notes that the employer can then hold an employee accountable for activities outside of work that aggravate the work-related injury.
The ultimate accountability comes from tracking data. Are your injury rates going down? What about lost time days? Or the cost and number of indemnity claims? Top leadership in the hospital also needs to support the program. “Everybody in the organization needs to know and understand the role that they play,” Brennan explains.
• Respond to injuries immediately.
Timing is everything. Prompt medical care may help employees recover more quickly. Getting back to work right away, even if it’s restricted duty, will help them transition back to their original position. To support that system, make sure each department has transitional duty jobs available, Gould advises. Winona Health moved the cost of the transitional duty out of the individual department budgets and tracks it separately to make it more palatable for supervisors. “Previously, we sent communications out to managers and asked them if they needed any additional work in their areas,” he says. “But managers really didn’t have an understanding of why we were doing this or how it would impact their budget.”
Meanwhile, cases are reviewed at least weekly and the work injury management team meets every other week. “We’re actively managing the cases we do have and really working with employees to make sure they’re in proper treatment, with the goal of getting them back into their pre-injury position,” Gould points out.
• Deal with the few abusers of the system.
Some people will try to take advantage of the workers’ compensation system. They may be repeat filers of claims. They may skip appointments and fail to show up for alternate duty. “Certain employees with high-risk behavior are going to act out and test you and your injury management program. What they count on is the injury management lead or manager/supervisor backing away from the conflict,” Brennan notes. “The result is the employee is left alone to drive the case, so to speak, and costs skyrocket.”
Simply follow through with your policies, following up with phone calls and using disciplinary procedures, if necessary, she advises. Eventually, they will either straighten up or find another job. “They will take themselves out of your work environment because they won’t want to go through this,” she says.