by Bryce Davis, Field Manager, PreCare Inc.
Workplace (Corporate) Wellness programs – Why are they important? How does the Employee benefit? How does the Employer benefit? These are all questions that have been surrounding Corporate Wellness Programs for years, however as more programs are developed and larger pools of information are accessed, these answers are being defined with additional clarity and specificity.
Presenteeism
Workforce health and medical costs have been attributed to the ‘bottom-line’ of corporations, both large and small, for decades. This appeared to be a relatively straightforward problem with easily addressable solutions (i.e. Medical Costs, Pharmaceutical Costs, etc). However, according to the study Health and Productivity as a Business Strategy: A Multiemployer Study completed by the American College of Occupational and Environmental Medicine; the one area not addressed with enough attention was Lost Productivity, particularly lost productivity due to “Presenteeism” (a situation that develops due to a medical condition or illness: an employee shows up for work, but cannot perform his job at full capacity). Some of the major factors involved in “Presenteesim” are obesity, arthritis, depression, anxiety, chronic pain, and back and neck pain (Loepke MD, et al., 2009). It is estimated that the overall impact of poor health on the workplace is estimated at $1.8 trillion (Statistics, 2009). It has been these revealing statistics, as well as many others, that have brought about the transformation of current Corporate Wellness Programs.
Workplace Wellness
Workplace Wellness programs can range from providing Health Risk Assessments, Annual Blood Pressure Screenings, group exercise classes, providing pamphlets on specific health concepts and exercise, to individual health assessments and structured guidance based on employee specific metrics and goals. Wellness Services are provided in many different formats; virtual, one time onsite training, program development from an outside source with implementation by the corporation’s staff, and implementation of a Wellness program using specific onsite staffing.
The benefits to utilizing an onsite clinician to initiate employee-centric programs are multidimensional; increased employee motivation, encouraging follow through and commitment to the program, specific modification to an employee’s program mid-stream, and early recognition of risk factors and potential life threatening illnesses, e.g. High Blood Pressure. The Workplace Wellness program PreCare Inc. has developed was designed to be personal, educational, and directionally specific to the questions and goals the employee presents. This program allows a clinician to systematically direct employees within their current health and wellness goals, while helping provide direction and proper access to their current health care benefits, i.e. Primary Care MDs, Dentists, Ophthalmologists, Annual Physicals and Exams, etc.
The onsite clinician has the ability to offer specific classes, both group and individual, on topics that are relevant to the employee and the employer as a whole site, i.e. Physical Activity Guidelines, Balancing Calories and Intake, Nutrition, Strength Training, and Overall Wellness Guidelines. The onsite clinician provides the most important part of a successful Wellness Program: Education and follow up. Comprehensive and continuous education continues to be the “X” factor in the outcomes derived from Corporate Wellness Programs. A quality program alone will not provide the results a corporation is seeking, without the consistent and knowledgeable follow up from a health professional, usually over an 8-12 month period.
Tangible Results
Within the initial 12 months of implementation, PreCare, Inc. has noted tangible and positive employee specific changes in response to the program. PreCare’s onsite clinicians are also in the position to recognize potentially serious health issues and immediately refer the employee for medical intervention. During routine blood pressure checks for the wellness program, onsite clinician noted a significantly high blood pressure (>180/145) with one of the employees, in conjunction with reported severe headaches and dizziness. The EE was referred to the nearest ER and admitted for observation and proper treatment.
Providing employees with the proper tools (education) and resources to maintain their health is essential when attempting to maintain a positive workforce and high levels of productivity. This type of program not only helps maintain the health of the employee, but also contributes to a healthy bottom-line by lowering healthcare costs!
Works Cited Loepke MD, R., Taitel PhD, M., Haufle MPH, V., Parry PhD, T., Kessler PhD, R., & Jinnett PhD, K. (2009). Health and Productivity as a Business Study: A Multiemployer Study. Journal of Occupational and Environmental Medicine, 411-429. Statistics, B. o. (2009). The Employment Situation: December 2008. Washington, DC: US Department of Labor. 
Protecting Our Workers and Ensuring Reemployment (POWER)
The President established the "Protecting Our Workers and Ensuring Reemployment" or “POWER” initiative to improve workplace safety and the health of federal employees, while also reducing hardship, dislocation, and financial costs that often result from on-the-job accidents. The POWER Initiative sets aggressive performance targets, encouraging the collection and analysis of data on the causes and consequences of frequent or severe injury and illness, and prioritizing safety and health management programs that have proven effective in the past.
Goals of the POWER Initiative
Goal 1 - To reduce total injury and illness case rates by 4% per year below the FY 2009 baseline if an agency's rate is at or above the national target or by 1 % per year if an agency's rate is below the national target.
Goal 2 - To reduce lost time injury and illness case rates by 4% per year below the FY 2009 baseline if an agency's rate is at or above the national target or by 1 % per year if an agency's rate is below the national target.
Goal 3 - To analyze lost time injury and illness data. While all agencies are encouraged to do so, only those agencies with a lost time case rate above the federal government's rate are required to submit, as part of the annual report to the Occupational Safety and Health Administration (OSHA), a summary of the measures taken to address the most frequent and severe cases.
Goal 4 - To increase the timely tiling of workers' compensation notice of injury or illness forms (forms CA-J and 2) by 3% per year above the FY 2009 baseline or meet the minimum tiling percentage for the year, whichever is greater. Minimum performance thresholds start, at 65% for FY 2011 and rise by 5% per year. However, no agency's annual goal will need to exceed 95%.
Goal 5 - To increase the timely filing of wage-loss claims (form CA-7) to meet or exceed minimum annual thresholds. In FY 2011, all agencies are required to achieve at least a 60% timely filing rate; in FY 2012, FY 2013, and FY 2014, the minimum thresholds will rise to 64%, 68%, and 70%, respectively.
Goal 6 - To reduce lost production day rates (days lost due to workplace injury or illness per 100 FTE) by 1 % per annum below the FY 2009 baseline or maintain a rate of 15 days or less.
Goal 7 - To increase return-to-work outcomes for those federal employees who sustain serious workplace injuries or illnesses. While all federal agencies are encouraged to improve their return-to-work percentages under the initiative, 14 agencies with the largest, statistically significant case volumes (an annual average of 45 or more new serious injury cases measured for the FY 2009 baseline) are expected to improve their return-to-work outcomes within a two-year period by 1 % in FY 2011 and by an additional 2% in each of the following three years over the FY 2009 baseline.
How can PreCare Help you achieve your Agency’s POWER Initiative Goals?
The Secretary of Labor recognizes that recent studies in the field of occupational disability, workers' compensation, and vocational rehabilitation strongly endorse early intervention strategies to improve return-to-work outcomes. That’s where PreCare comes in. PreCare return-to-work strategies not only reduce costs, but also provide injured federal workers with greater prospects for their successful return-to-work. Early intervention by PreCare’s trained disability personnel, injured workers tend to reduce their stay on the workers' compensation rolls and increase their hope of returning to regular employment.
Our consulting services are geared to help you meet and exceed all of your Agency’s POWER goals.
When the physical requirements of a job and the physical capacity of the worker don’t align, then musculoskeletal disorders can occur.
Ergonomics Defined
Ergonomics is variously defined, but generally is the science of fitting the job to the worker. It includes designing equipment and work tasks to conform to the capability of the worker, and it provides an approach for adjusting the work environment and work practices to prevent injuries before they occur.
Musculoskeletal disorders
Musculoskeletal disorders or MSDs is described by the National Institute for Occupational Safety and Health (NIOSH) as:
- disorders of the muscles, nerves, tendons, ligaments, joints, cartilage or spinal discs
- disorders that are not typically the result of any instantaneous or acute event (such as a slip, trip or fall) but reflect a more gradual or chronic development
- disorders diagnosed by a medical history, physical examination, or other medical tests that can range in severity from mild and intermittent to debilitating and chronic
- disorders with several distinct features (such as carpel tunnel syndrome) as well as disorders defined primarily by the location of the pain (i.e., low back pain)
Preventing Musculoskeletal Disorders Through Implementation of An Ergonomics Program
An effective occupational safety and health program that addresses ergonomic hazards includes the following major program elements:
Management Leadership/Employee Involvement
Management leadership and employee involvement are important elements of an effective workplace safety and health program. Management commitment provides the resources to deal effectively with ergonomic hazards, while employee involvement through clearly established procedures helps to identify existing and potential hazards and develops an effective way to abate such hazards.
Workplace Analysis
Workplace analysis identifies identify potential ergonomic problems before employee injuries occur. Consideration of ergonomic-related problems in similar industries helps identify and solve problem areas. Workplace analysis may include Ergonomic Assessments as well as passive and active surveillance of incident and/or claims data. Data analysis includes close scrutiny and tracking of injury and illness records to identify patterns that may indicate development of MSDs.
Hazard Prevention and Control
Once ergonomic hazards are identified, designing prevention and control measures should be next. Such controls should encompass engineering controls, administrative controls, behavioral/training controls, and personal protective equipment.
Medical Management
Implementing appropriate medical management is needed to eliminate or reduce the risk of musculoskeletal disorders through early identification and treatment. A successful program will use health care professionals as part of the team in order to prevent and properly treat MSDs.
Training and Education
Good ergonomics training enables managers and employees identify aspects of job tasks that may increase a worker’s risk of developing MSDs, recognize the signs and symptoms of disorders, and participate in development of strategies to control or prevent them. Ergonomics programs should be designed and implemented by qualified persons and tailored to the specific concerns in the workplace.
Lots of people are exposed to heat on some jobs. Operations that can cause heat-related illness include:
- high air temperatures,
- radiant heat sources,
- high humidity,
- direct physical contact with hot objects, or
- strenuous physical activities
Every year, thousands of workers become sick from occupational heat exposure, and some even die. These illnesses and deaths are preventable and therefore OSHA has released some new guidance on their website.
Why is heat a hazardous?
When a person works in a hot environment, the body must get rid of excess, mainly through circulating blood to the skin and through sweating. But when the air temperature is close to or warmer than normal body temperature, cooling of the body becomes more difficult. If the body cannot get rid of excess heat, it will store it. When this happens, the body's core temperature rises and the heart rate increases. As the body continues to store heat, the person begins to lose concentration and has difficulty focusing on a task, may become irritable or sick, and often loses the desire to drink. The next stage is most often fainting and even death if the person is not cooled down.
Some environmental and job-specific factors that increase the risk of heat-related illness.
Environmental Factors –
- High temperature and humidity
- Radiant heat sources
- Contact with hot objects
- Direct sun exposure (with no shade)
- Limited air movement (no breeze, wind or ventilation)
Job-Specific
- Physical exertion
- Use of bulky or non-breathable protective clothing and equipment
Also, employees that are swiftly exposed to working in a hot environment face additional and generally avoidable hazards to their safety and health. New workers are especially vulnerable. Preparing for heat related occupations should be trained on the dangers of heat, how to acclimate, and tactics for building tolerance for high heat.
Other topics covered in this OSHA guidance include:
- How to tell if it is too hot.
- Ideas for preventing heat illness.
You might be surprised to learn that for many industries, the biggest financial and personal losses are not due to accidents or hazardous working environments. The largest losses are from the repetitive lifts, pushes, pulls, gripping, and pinching that over time result in pain and eventual dysfunction. For most companies, approximately 40% of their workers compensation claims are due to strains and sprains.
While the frequency of lost time claims continues to decline each year, with a cumulative reduction of 55% between 1991 and 2008, the bad news is that indemnity costs have grown. Here are four key points to consider in developing your program to address this problem.
1 – Identify what you are doing right?
The typical occupational health and safety injury prevention program includes traditional employee education programs such as proper lifting techniques training and back injury safety education. And many programs offer an active safety team of ergonomists and/or engineers to help identify risks and implement interventions to reduce employees’ exposure to the physical risk factors that cause injury. So if you are doing these things, that is great, but it may not be enough because it may not achieve the desired results - decreased frequency AND severity of injuries. The problem is the absence of a comprehensive and analytical approach to identifying risks in the workplace, prioritizing them, and then providing precise, targeted solutions for long-term impact. So here are three more things to consider.
2 - Performing an integrated risk assessment- leading, lagging, and personal indicators
The first step is to identify the workplace safety problems by completing an integrated risk assessment with the objective of identifying, quantifying, and prioritizing risk. This is most effectively done using three types of data: lagging indicators (e.g., Injury logs), leading indicators (e.g., screening and assessing risk factors), and personal data (identifying those at risk for injury and focusing resources to prevent injury).
3 - Identifying, prioritizing, and implementing targeted solutions
Once risks are prioritized, it is critical that effective, targeted solutions be implemented in an efficient manner. The need for action cannot be underestimated. Action promises many benefits including
- reducing physical risk factors,
- collaboratively engaging management and employees, and
- increasing employee morale.
4 - Measuring long term impact
A comprehensive risk assessment and targeted approach to risk reduction is effective in reducing musculoskeletal injuries. Regardless of the injury prevention improvements seen, one injury is too many and we should always strive to make our injury prevention programs better. Measuring the long-term impact of injury prevention programs is a critical step to ensuring a program’s effectiveness.
For more information on this topic, please download our free whitepaper, Reducing the Primary Cost Driver of Workers Compensation: Sprains and Strains.
Time lost due to a worker's personal injury reduces productivity, costs money, and can negatively affect a worker’s perception of his or her job and employer. And the detrimental effects do not stop there. The injured employee is at risk for physical and emotional distress that hinders recovery. His or her co-workers are at risk for an increased work load, increased risk of injury and/or a reduction in morality. Management-employee relations often become strained and the financial consequences are commonly felt company wide. Effectively helping your employees prevent injuries at work, and treating them if they do occur is critical in minimizing the negative impact of a work-related injuries.
One critical factor in how a work-related injury affects a company is how quickly the employee returns to work. A speedy return to work benefits everyone- the injured employee, his or her co-workers, and of course, the employer. For the injured employee, the familiar concept of "use it or lose it" has been bolstered by studies showing that increased time spent off work prolongs the healing process and makes an eventual return to work more difficult. The ability to work is an important part of an employee's identity, self-esteem, and ability to support one's family, making a quick return to work imperative. Further, the way a company responds to an injury is extremely important in employees perception of the company and their overall job satisfaction. A caring company will foster caring and hardworking employees.
So what is the right response?
Although there are many factors that are important in a company’s response to an injury, physical therapy is the key in restoring function by improving employee’s:
- Fitness
- Strength
- Flexibility
Restoring lost function is the key to returning an employee to work, and physical therapists are the experts in improving physical function. The sooner an injured employee can be seen by a Physical therapist, the better. In fact, onsite Physical Therapy is a strategy that companies use to provide an immediate intervention that enhance outcomes by providing therapy in the work setting on real work tasks.
Onsite Physical therapists can provide job specific, employee-specific job coaching to assess gaps between the physical demands of a job and the capabilities of the injured employee as they are healing. The physical therapist can provide education in proper:
- Body mechanics,
- counter-balance stretches and
- best practice
Such education not only facilitate an employee returning to work after an injury, but reduces the risk of re-injury.
Most importantly, onsite physical therapy restores and employee’s confidence in their ability to work pain free, which makes returning to work feasible and desirable. A successful and supported return to work for one injured employee will be noticed by all. The benefits in employee morale, job satisfaction, and productivity by the injured employee and his or her co-workers will far outweigh the direct cost associated with the care of one employee.
While some employers send injured employees to offsite clinics for treatment following injury; over the years, PreCare has continuously delivered innovative onsite treatment services to expedite recovery of injured workers by treating them in their own work environment. This treatment service model provides the best possible means to assess how injuries occurred in an effort to help avert future mishaps. Here are 6 reasons why onsite treatment is better than offsite treatment:
Better Productivity – Travel to and from offsite clinics takes time and reduces productivity. With onsite treatment, no travel or waiting is required so you maximize productivity from your workforce.
More Treatment Time – With an offsite service model, the amount of one on one treatment time for your employees typically averages 30-40 minutes. With onsite treatment from PreCare, each employee receives a full 60 minutes of individual treatment from our Physical Therapist, thus facilitating recovery and improving the quality of care.
Equivalent Modalities – At first glance, one might think an offsite clinic may offer more equipment and treatment modalities. PreCare onsite treatment, however, covers all the same modalities as offsite clinics, including Ultrasound, E-stim, Tens, etc.
PreCare clinicians arrive at the employer’s site with all materials they will need, including a treatment table, other required equipment, modalities and conditioning tools. All required materials are provided at no additional costs to the employer.
Privacy – offsite clinics typically occur in large open rooms with curtains. Onsite treatment takes place in a designated private area with one-on-one clinician treatment.
Incorporating job tasks into treatment – At offsite clinics, job tasks can only be simulated. PreCare’s onsite physical therapy delivers treatment in the context of the employee’s actual job tasks. During the course of treatment, we will build in a functional strengthening component where actual work tasks become the focus of the treatment program
Payment - Offsite clinics bill for services using multiple CPT codes with the fee schedule. PreCare onsite treatment is billed using one CPT code and fee schedule does not apply.
An Onsite Treatment Service model from PreCare delivers clinical expertise that improves the quality of care, reduces the number of treatment visits required for each claim, reduces the cost of each claim and improves productivity while reducing the overall treatment cost for your organization.
by Stefan Schultz
Physical therapists working in outpatient orthopedic settings can be a picky group when it comes to their work environment. In an ideal world we’d all have a large, well-lit space with good privacy options. We like the latest rehab equipment and modalities. We like our patients to enjoy coming to the clinic for what would otherwise be a drag on their day. This is true especially when dealing with worker’s compensation injuries and the inherent difficulty to schedule patients around their work schedules, and having to “sell” the importance of their treatment should they have something better to do than drive 30 minutes to a clinic after a hard day’s work.
After several years of treating patients onsite, at their place of work, I have gained a deep appreciation of the numerous benefits of taking treatment to my patients; even if this means at times performing manual therapy or supervising therapeutic exercises in, shall we say, unorthodox settings. I distract O-A joints in electrical closets. I demonstrate proper abdominal stabilization techniques over a rumble of production lines. I perform manual resistive exercises against a backdrop of alert sounds emanating from forklifts just outside my humble treatment space.
So what’s the draw?
More likely than not, I can find a manager on a moment’s notice in order to determine the best time in the day to treat any particular patient. More likely than not, I will know who my patient is even before he walks in for his first appointment – I will know first-hand how his injury was sustained. And, most importantly for the success of my treatment plan, I will have intimate knowledge of this patient’s job, the nature of his most common work tasks, and which physical demands prevent this patient from returning to his job without restrictions.
Sooner or later during the course of treatment, I will build in a functional strengthening component into the session. Because I’m not a prisoner of the confines of my shiny clinic, I just take my patient to his workstation where actual work tasks become the focus of the rehab program. There is no need to approximate the weight of a load the patient has to lift with wooden boxes bearing no resemblance to the actual work task. Instead, I have the luxury of having my patient practice good body mechanics using the actual item he needs to lift every day.
No shows? If my patient doesn’t show up within 10 minutes, I will find him.
I often wonder why workers get the short end of the stick when it comes to the design of a treatment plan specific to their situation. In any outpatient sports clinic, there is no question that the rehab plan for the golf player with low back pain should look different from that of the competitive rower with the same problem. Physical therapy needs to approach workers with the same dedication to task-specific functional outcomes as it affords injured athletes. Workers are athletes too – industrial athletes.
Injured workers respect practitioners who intimately know their work. Who know that it takes 12 distinct mattress lifts to make a bed in a hotel room. Who know that using a palm-down grip to scan a can of tomatoes might not be the best habit for a retail cashier with wrist tendonitis. Or who can teach how to properly turn a full wine barrel to a cellar worker with low back pain. This kind of respect often pays off in positive outcomes such as successful return to work, reduced number of treatments to discharge, and reduced rates of re-injury.
It’s not hard – all it takes is to get out of your clinic every once in a while and see with your own eyes what your patients do every day.
Strategic Injury Prevention Program Planning:
Part III- Measuring Long Term Impact
Integrated risk assessments identify and prioritize the physical risk factors that cause musculoskeletal injuries and drive workers compensation costs. Targeted solutions that incorporate three components, solution type, recipient, and delivery method are effective in optimizing the time and resources that a company can focus on injury prevention. But how do you know the program is successful? How can you be confident that your Injury Prevention Program is actually preventing injuries AND saving money?
There are three steps to ensuring that your program is working for you.
The first step is quantifying the reduction in key physical risk factors that were driving injury rates and workers compensation costs. There are many tools that can be used to do this such as the NIOSH Lift Index, quantifying repetition or duty cycle, or even providing surveys to employees following key trainings.
The second step is tracking injury frequency and severity by injury type, body region, and location. Reductions in frequency and/or cost should lag slightly behind the implementation of solutions.
The third step is to calculate a return on investment for your program. Arguably this is a difficult endeavor but a particularly important one to substantiate future spending on injury prevention programs. A key consideration is the indirect cost savings assumption. This should be conservative, clearly identified and agreed upon by key stakeholders of the program prior to the ROI being generated.
Related:
Strategic Injury Prevention Program Planning: Part II- Implementing Targeted Solutions
An integrated risk assessment allows the identification and prioritization of the risk factors causing musculoskeletal injuries. So, what’s next? Having a list of “problems” can be overwhelming because not all issues can be addressed at the same time. Due to time and money constraints, a strategic approach is needed to match the most effective solution to the problem.
Consider three components to the targeted solution: Type, Recipient, and Delivery.
Type
The first component is the type of solution:
- Engineering/ Environmental Modifications,
- Behavior Modifications, and
- Administrative Controls.
Engineering and environmental modifications such as modifying workstations or providing new tools, are often the most effective in eliminating physical risk factors, however they can also be costly.
Behavior modification can be effective, but only if incorporated consistently over time. The one shot wonder training programs are frequently a waste of time and money.
Administrative/management controls such as task rotation or task sequencing can also be very effective but can be more complicated to implement. Each of these solution types have their benefits and drawbacks and should be considered carefully when addressing an ergonomic issue. And they should not be considered independently. Solution recipient and delivery also needs to be factored in.
The solution recipient is a critical component to determining the most cost effective, targeted solution. Solutions can be implemented company-wide (such as the standard way a workstation is set up, or a mandatory safe lifting training program), specific to certain departments or jobs (such as a tool modification used in one or more jobs), or specific to an employee (such as ordering a new chair for use by one employee). The key is choosing the type of solution best suited for the target recipient and knowing why.
The final component to consider when implementing targeted solutions is the method for delivery. Having a variety of delivery methods allows cost effective decisions to be made. Interactive online tutorials, presented to individuals or groups, work very well in dispersing information on general physical risk factor avoidance and best practices. For primary loss drivers such as low back injuries, a lift training program can include a tutorial company wide, and onsite clinicians/experts to deliver follow up educational sessions specific to high risk departments/jobs, and high risk individuals.
Ultimately, considering all three components when choosing a solution to mitigate identified physical risk factors that drive workers compensation costs will be most effective in reducing injuries and the direct and indirect costs associated with them.