February 2010



Best Practices

Integrated Approach to Safety
Fewer Lost-Time Incidents & Greater Productivity

Cost savings are important for employers at any time, but even more so during an economic downturn. Now more than ever employers and employees are aligned with complementary goals of staying in business and staying employed. This like-mindedness presents an opportunity for companies to launch, expand, and/or integrate workplace programs aimed at promoting safety, health and wellness in order to cut costs associated with work disruption and absenteeism and to maintain productivity. Taking a shotgun approach—launching multiple programs to determine what works—is ineffective. Instead, employers should assess existing programs to see how offerings can be integrated and to identify programmatic gaps that need to be filled. Specific needs will vary among employers, even for those with well-established and sophisticated programs in place.

Asking the Key Questions
To achieve a safer, healthier work environment with fewer lost-time incidents and greater productivity, employers must evaluate program effectiveness. This begins by identifying the disability management problems and risks that are prevalent in the workplace and by analyzing how effective programs are. This can be accomplished by asking tough questions.

  • Authority, accountability and responsibility: Do programs spell out and determine who is responsible for carrying out important tasks?
  • Internal and external communication: Is consistent and accurate information provided about the operational aspects of programs to managers, supervisors, employees, labor representatives, physicians, claims managers and adjusters, and other service providers?
  • Benefit design and influences: Are programs designed to influence and reward safe behavior in the workplace and speed return to work?
  • Injury, disability and lost-time patterns: Can quality data be obtained to enhance or design programs that are responsive to the organization’s needs?
  • Workforce and cultural dynamics: Are there other dynamics and influences in the organization, such as aging employees, multicultural workforce, language barriers and challenges, ergonomic needs of people of smaller or larger stature, and cultural awareness and educational needs?

While hardly exhaustive, these questions reveal a host of issues that should be explored in order to determine how various parties, including how human resources, risk management, occupational safety and health, and disability managers, deal with workplace issues. Do the parties function separately or do they collaborate? What is the level of integration among programs and do those involved see the bigger picture? “Employers cannot design an effective approach without understanding the exposure that they face,” says Darryl C. Hill, CSP, vice president, safety and health, for ABB Inc., and ASSE President-Elect. “Once the exposure is identified, then a strategy based on the expertise and background that the different groups or parties bring to the table, can be developed to take a holistic approach to injury prevention.”

Establishing a multidisciplinary approach to creating a safer and healthier work environment must be supported by a top-down commitment from management to line supervisors and then to employees. Better integration of programs can improve return to work for employees who are off the job due to illness or injury, whether occupational or nonoccupational. Moreover, offerings such as health, wellness and safety can reduce the number of lost-time incidents, which in turn will decrease costs and improve productivity.

Collaborating on the Worksite
Sitting around a table and discussing ideas is one thing. However, real collaboration among human resources, health and wellness, disability management and safety happens “on the shop floor, on the jobsite,” says James “Skipper” Kendrick Jr., CSP, president of Kendrick Global Enterprises LLC, and an ASSE past president. “We can sit and we can talk, and I’ve seen a lot of good plans and proposals written. But the best thing is to get out there together in order to appreciate what’s going on in the workplace.” As involved parties collaborate, they must orient to the risks and problems that exist in the workplace rather than focus on their own specific program or area. “Once the exposure is identified, then, based on the expertise and background of each party and what each different group or party brings to the table, you can develop a strategy on how to look at it as part of a holistic approach to injury/prevention,” Hill says.

As teams come together, it is essential to establish a safe environment for discussions of problems and challenges without blame. At a recent meeting with a large employer in the construction industry, for example, human resources, risk management and safety were brought together to address costs associated with lost time, which amounted to $36 million over a 6-year period. The first message delivered at the meeting was that no one was “in the hot seat,” as the purpose of the gathering was not to assign blame. A consensus was established quickly to evaluate programs to differentiate between what was effective and ineffective, and to make programs with good results even better.

Companies also can learn from the experience of other employers. A certified disability manager who consults with a variety of companies, for example, can share the results of programs that have been rolled out in several companies. “To be effective in preventing and mitigating the effects of injuries and illnesses at home and on the job, disability management professionals must work collaboratively with professionals from other disciplines and be knowledgeable about empirically supported medical, psychological and vocational interventions in order to serve workers effectively,” says David Rosenthal, Ph.D., associate professor and chair of the Department of Rehabilitation Psychology and Special Education at the University of Wisconsin-Madison.

Evaluating Potential Cost-Saving Programs With an aging workforce and a challenging economic situation, many employers are looking for new, cost-effective ways to reduce liability. To some degree, many strategies have been around for years, but they have failed to capture the attention of employers or have not been effectively maintained and emphasized over the years. It can be difficult to admit, particularly in the presence of upper management, that a program has not met expectations or that an initiative has failed to reach its goals. However, suggestions for improvement can be made without blame. Let’s take a look at how to approach and reignite interest in these well-established principles:

  • Global assessment. Whether undertaken internally or by outside consultants, the assessment evaluates programs to identify strengths, weaknesses, effectiveness and needs.
  • The human machine. Understand the failures of the human machine and common injuries/ illness that occur in the workplace (e.g., strains, carpal tunnel syndrome, back problems).
  • Analyze risk factors. Identify tasks that involve repetitive motions, awkward postures, extreme force, mechanical stress, prolonged vibration and extreme temperatures. An excellent training activity is to have supervisors generate a list of tasks performed on the job that could relate to injury and compare that list to risk factors.
  • Measures to control risks. This includes a variety of methods that individuals and companies may employ to help decrease the likelihood of suffering injuries from work, home and/or recreational activities. Injury data, surveys/questionnaires, performance indicators, job observations, task design, workers’ posture, repetition, force, rate/pace, duration and recovery are just some of the information needed to identify important aids and administrative tools to minimize injury exposures.
  • Employee wellness and conditioning/stretching program. Teaching workers about the need for a well-rounded wellness program will promote a safer and injury-free workplace and better quality of life in general. Stretching programs that focus on muscle groups used daily by workers and that are at risk of injury can reduce the potential for injuries.
  • Injury management and return to work. Unfortunately, injuries will happen. To reduce workers’ compensation costs, severity must be reduced. Employers need to look at workplace policies and procedures to address lost-time claims. Many employers think that when an injury occurs the responsibility for getting the injured worker back to work shifts to the claims adjuster/insurance carrier. Employers must have an action plan, a policy and procedures that address return to work following a workplace injury.

A Holistic Approach
A company stretching program might sound like a flavor-of-the-month initiative imported from the Japanese auto industry in the 1980s. Although the Japanese did incorporate this practice (to the surprise of many corporate counterparts), stretching has many well-established benefits. Physical therapy and rehabilitation programs often include stretching to prepare the body for exercise programs and activities of daily living. For example, a stretch-and-flex program established for a construction company, with workplace demonstrations and large posters with illustrations, was received and accepted company-wide. Employees were instructed to stretch before their shift, after they returned from lunch and at the end of their shifts. Although some joking and teasing was observed initially, as soon as the right people led the stretches—the foreman and the job superintendent—employees became more serious about participating, and experienced firsthand how the exercises could improve range of motion, balance, flexibility, circulation and body awareness. Employees soon began to integrate stretching into their daily routine, both on the job and at home.

“Safety, health and related disciplines need to look at the whole prevention piece from a holistic standpoint,” says Hill. “Workplace safety and health to prevent injuries and illnesses is very important. Nonetheless, the statistics show that the majority of injuries occur outside of the workplace.”
Injury prevention outside of the workplace centers on safety at home, diet, exercise and healthy behaviors to engage not only the employee, but also the family. At ABB, the holistic approach has brought safety and health into partnership with human resources, Hill adds. The line between occupational and nonoccupational incidents can blur. An injury that happens in the home (e.g., a back strain) can cause a weakness or risk that results in a later injury. Conversely, a workplace injury can lead to other health risks, including depression, which increase short-term disability costs and absenteeism. Therefore, promoting safety, health and wellness in every area of an employee’s life reaps benefits across the spectrum. For this to occur, however, programs must be evaluated for their effectiveness in dealing with issues germane to an employee population.

“When you look at the bottom line of any business, whether in construction, machine shops, aerospace, the service industry or whatever industry that is involved, if an employee is not at work, the business suffers,” says Kendrick. “Whether it’s due to back strain from working in the yard or from lifting a tool at work, that employee is not available in the workplace today.”

Measuring Results Interest in offering programs to prevent lost-time incidents has grown despite the economic downturn because employers understand that the costs associated with employee illnesses and injuries are not going away. Many companies recognize that eliminating programs to cut costs is short-sighted. In fact, with employees expected to be even more productive, this is an opportune time to implement programs and increase the effectiveness of existing offerings in order to reap cost savings in the long run.To measure effectiveness, some companies may attempt to determine the return on investment (ROI). Kendrick, however, cautions that this may not be the most accurate terminology to use with workplace programs. “If we put in a piece of equipment we know we are going to be able to ratchet out another 100 parts per shift, which will allow that machine to pay for itself over a certain number of months or years. Therefore, then it’s going to give us that ROI,” Kendrick says. Strictly speaking, workplace programs such as safety and prevention initiatives will not yield a clear, classically defined ROI, although it may be possible to look at factors such as cost avoidance from reduced injuries and claims. “But I can’t realistically look an executive in the eye and say, ‘This is an ROI issue,’” Kendrick says. “You have to look at these programs from the standpoint of it being the right organizational investment. It’s the right thing to do.”

Donald Gonzales, M.S., CRC, is a commissioner of the Certification of Disability Management Specialists Commission. He is also an absence, health and productivity consultant at Zurich North America. He has more than 15 years’ experience developing, administering and consulting workers’ compensation programs, short-term and long-term disability benefit plans, leave management and lost-time management strategies.

 

Employee Maintenance
An Effective Safety & Wellness Strategy

Workplace injuries are a burden to businesses and employees in all sectors. Economic and human impacts affect companies as well as employees and their families. On the economic side, for example, $55.3 billion was paid out in workers’ compensation claims in 2005, according to NSC. This figure represents only direct costs, which include medical and lost-time expenditures, costs that insurance covers. Also significant are the indirect or soft costs associated with overtime, decreased productivity, worker replacement, investigations, lower morale, increased absenteeism, administration and claims management. According to Liberty Mutual Insurance Co. in 2001, for every dollar spent on injury-related direct costs, $3 to $5 are spent on indirect costs. These costs are absorbed by the company, typically on the site or local level.The impact on the injured worker can be equally painful. The inability to work brings with it economic hardship, strain on the family, psychosocial implications and, on occasion, the fear-avoidance behavior that can negatively impact return to work. Fear-avoidance is the concept whereby the injured employee, unable to work for a period of time, develops a fear, rational or irrational, of returning to work after injury.

What Can Be Done?
To begin, let’s look at what has been done. Many companies establish safety departments, safety teams and implement safety engineering. The focus of these efforts is geared toward prevention and often consists of education, awareness, ergonomics, PPE and engineering. While it is certainly true that safety programs and safety engineering pay dividends, it is reasonable to suggest that no company has developed an impenetrable immunity to workplace injuries.Historically, the response to workplace injuries has been largely reactive in nature. These reactions include in-house incident investigations, environmental and ergonomic fixes, and opening of workers’ compensation claims. Additionally, reactive injury rehabilitation in the healthcare system often fails workers and companies by not returning injured employees to work with the ability to tolerate their job’s physical stresses without reinjury. As it relates to safety, prevention and workplace risk reduction, it is employees’ knowledge and awareness that has traditionally been targeted.

What has often been overlooked is the concept of biophysics. Biophysics relates to the physical attributes employees must possess to safely perform the physical tasks of their jobs without incurring injury. Biophysical characteristics include muscle strength and flexibility, joint range of motion and endurance. Simply put, the stronger and more flexible the employee, the greater the level of physical stresses that employee will tolerate without experiencing an injury.Companies spend tremendous resources to maintain their equipment, tools and facilities. Preventive maintenance of these items helps ensure that productivity is maximized and that interruptions in business are kept to a minimum. What about employees? Should they not be maintained as well? Would maintaining employees not yield similar benefits to those achieved by maintaining equipment, tools and facilities?

Employee Maintenance
An emerging focus of safety in recent years has been on just that—employee maintenance. Employee maintenance is the mechanism by which employees’ biophysical traits are addressed to identify risk, to improve musculoskeletal health and to address an often overlooked area of injury prevention potential. With strength and flexibility testing, employees’ deficits and limitations in these areas can be identified as part of a risk identification strategy. Once identified, these risk areas can be addressed with joint-specific strengthening and conditioning exercises, as well as targeted flexibility routines. Pain is another area in which employee maintenance has a preventive impact. No employee is immune to occasional aches and pains, work related or otherwise. While they are a part of life, the injuries into which they can develop, if left unchecked, should not be considered a normal cost of doing business.

Employee maintenance’s function as it relates to pain is to ensure that employees’ symptoms of discomfort do not develop into more significant problems such as injuries and costly claims. An effective employee maintenance program ultimately creates a mechanism and provides the convenience by which employees find it easy to be proactive about their musculoskeletal health, and their aches and pains.In making the case for employee maintenance as part of a safety program, consider that the types of injuries this program is specifically meant to address have an impact on companies’ bottom lines. According to NSC, the number of workers’ compensation claims in 2006 relating to “sprains, strains and overexertion” injuries far exceeded those relating to “macrotraumas.” In fact, such injuries accounted for more than 1.4 million claims while the top three macrotrauma injuries, contusions, fractures and cuts/lacerations, each accounted for between 250,000 and 350,000 claims. Per the same source, the 2006 direct costs for sprains, strains and overexertion injuries exceeded $25 billion while the total cost was estimated to be between $75 and $125 billion. It is these types of injuries in particular that an employee maintenance program has the greatest ability to impact.

When considering that the U.S. workforce is aging, the argument for employee maintenance becomes even more compelling. The first of the baby boomers reached age 63 in 2009. As more members of this generation approach retirement, they will comprise a greater percentage of the workforce. This will present an ever-increasing challenge to managing workplace safety, mitigating risk and preventing workplace injuries. A key to getting ahead of the curve is increasing the focus of safety and prevention programs on employee biophysics. Employee maintenance programs must ultimately become part of the forward thinking that will tackle biophysics to ensure that aging employees maintain standards of fitness for duty.

Practically speaking, for an employee maintenance program to be successful it must be appealing to and accepted by all employees. Several elements contribute to such a program’s utilization. Among them are: on-site convenience, skilled staff who serve as effective coaches for the industrial athlete, low or no cost to employees, and tools, equipment and technology that effectively reduce pain and increase musculoskeletal health.In short, an employee maintenance program must ultimately be a more attractive option than traditional healthcare. In today’s world, with ever-increasing insurance deductibles, premiums and copays, the attractiveness of the healthcare system has diminished as a mechanism for workers to obtain the care they need. The result is that employers may end up with the bill for on-the-job injuries that started as nonwork-related conditions. The question that companies must examine is, where do we spend the dollars? Do we reactively spend them on higher premiums for employee medical benefits and workers’ compensation claims, or do we proactively spend them on prevention in the form of employee maintenance? In this author’s experience, funds are far better spent on prevention programs that address employees’ biophysics.

Return to Work
As effective as an employee maintenance program is in addressing aches and pains, it cannot prevent 100% of injuries. However, when set up correctly, such a program serves a secondary function: it will address the specific needs of the injured worker returning to the job. On-site convenience is critical for an employee maintenance program to effectively double as part of a return-to-work program. For the injured worker to maximize and maintain the benefit of a healthcare-based rehabilitation program, an on-site facility becomes the mechanism by which joint-specific conditioning is continued, beyond the point where the rehabilitation program ends. Such a facility provides a seamless transition between where healthcare-based services end and return to work begins. Additionally, because employee maintenance facility staff possess a detailed understanding of the injured worker’s job, they can provide job-specific strengthening and conditioning exercises. The result is a decreased likelihood of the reinjury. Furthermore, for the injured worker who does not require time away from work but who still needs a rehabilitation solution, an on-site facility allows the employee to access rehabilitation services while at work. Far less time away from the job is needed to attend doctor and physical therapy appointments, work continues and productivity is maintained. Savings are also realized by keeping an employee’s injury rehabilitation in-house versus having it occur in the outside healthcare arena. Finally, it is widely accepted that the longer the injured worker is away from the workplace, the greater the psychosocial impact and the greater role fear-avoidance plays in delaying if not precluding the return to work.

That said, is there an inherent value to an injured worker having the rehabilitation visits occur at the jobsite? Does showing up to the jobsite for rehabilitation visits foster and maintain a sense of routine as it relates to the job being a part of the injured worker’s identity? Does going to the jobsite for rehabilitation visits have a psychological impact on the injured worker’s confidence that s/he will ultimately return to work?

These questions are difficult to answer with measurability. However, given the potential costs associated with returning to work being delayed or not occurring, these are questions that must be considered. When used effectively an employee maintenance facility is an integral element of the return-to-work solution for the injured employee. More importantly, employee maintenance as a prevention mechanism cannot be overlooked. Benefits of such a program include reduced workplace risk, fewer workplace injuries, decreased absenteeism, increased productivity and improved employee morale. The product of these benefits is a solid return on investment, more robust bottom lines and increased competitiveness for businesses.

Benjamin Harris is a licensed physical therapist who operates outpatient orthopedic rehabilitation centers in Washington and is the Employee Maintenance Centers’ director for InjuryFree, which specializes in on-site injury prevention, ergonomics and ergonomic management software solutions. For more information, visit www.injuryfree.com. Harris will be a presenter at ASSE’s Safety 2010 conference in Baltimore.