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Safety
Solutions Monthly eNews for February 5, 2008 |
Welcome to Safety Solutions, the e-newsletter
that provides you with
ideas and information you can put to use in your workplace. Each
month,
Safety Solutions delivers articles focused on improving
occupational
safety and health programs, controlling costs and keeping
employees safe
and healthy at work and at home. |
In This
Issue:
1. Five Costly
Mistakes Employers Make with Workers' Compensation Managed Care
Organizations
2. Facing the
Unthinkable: Fatality Prevention in the Workplace
3. New Direction
Drives Safety Success at APAC-Missouri
4. Are You Talking
Too Much about Safety?
5.
Employers Must Post Injury/Illness Summaries
1. Five Costly Mistakes Employers Make
with Workers' Compensation Managed Care Organizations
By Frank Pennachio
While workers' compensation managed care widely is viewed as a means of
controlling expenses, the results are sometimes quite different from
what is expected. In fact, in many cases, the consequences are not only
unintended but also undesirable and costly to employers.
How is it that a system developed to manage the utilization of care and
costs associated with workers' compensation actually ends up costing
employers more than is necessary? Here are five common mistakes that
are often made when working with workers' compensation managed care
organizations (WCMCOs):
1. Employers assume that the goals of the WCMCO are aligned with
their goal of safely returning the employee to work as quickly as
possible.
When employers select a WCMCO, they believe they are engaging experts
who share their objectives, in the same way they choose an attorney or
accountant. On the surface this makes sense. When employees are injured,
the goal of the employer is to provide the right treatment at the right
time by the right physician so that the employees can safely return to
work as quickly as possible.
On the other hand, the aims of the WCMCO are more complex and require an
understanding of how they work. While they may share the employer's
return-to-work goal, they also have to make a profit. As a result, when
the WCMCO recruits physicians, they negotiate fees lower than those
mandated by the state, bill at the mandated price and pay the discounted
fees to the physician. The WCMCO is paid a percentage of the savings and
the balance is reported as a savings to the employer.
This arrangement has two unintended and undesirable outcomes. First, top
doctors are not attracted to the network. Second, it encourages
increased utilization - more visits, more tests, etc. to make up for the
loss of income.
2. Employers engage a WCMCO that does not have physicians who are
properly trained in occupational medicine.
The treatment of job-related injuries requires an expertise that
transcends the medical model followed by physicians who are trained to
treat pathology, disease and impairments. In workers' compensation
cases, there needs to be an understanding of the functional requirements
of the job, care coordination and communication with the employee and
employer, a knowledge of the how the employer can accommodate an injured
worker and a grasp of the important psychosocial factors involved in
returning to work.
The system sets the stage for undesirable outcomes. First, case
management is in effect, a rework because the right work is not being
done, adding another layer and more expense. Second, doctors do not
perceive nurses as peer review. Lastly, many case managers are not
properly trained, nor do they have the skills to coordinate and guide
this complex process.
In the white paper, "The 'Management' in Case Management," Byran Chong,
IBM Global Social Segment, notes, "Between 10 percent and 50 percent of
case managers in workers' compensation organizations are considered not
fully effective at what they do. These employees lack knowledge and
skills, and many are not motivated to improve."
3. Employers don't realize the importance of evidence-based
guidelines.
When concerns were raised with WCMCOs regarding over-utilization and
higher-than-expected costs, the companies developed "utilization
reviews" designed to monitor the care injured employees receive to
ensure that it is appropriate, necessary and efficient.
It makes sense to have proven medical protocols for injuries so that the
right treatments can be applied with the right schedule to get the
injured worker back to work. While these protocols exist, many WCMCOs do
not use them. Since the present system financially rewards the networks
when a claim goes bad, there is an understandable reluctance to adopt
these important measures.
4. Employers don't engage in relationships with medical
providers.
So much of managing the cost of disability claims is working with the
right doctor who can diagnose the injury correctly, knows the protocols
for workers' compensation injuries, and is able to put in place proper
guidelines for medical care and return to work. Rather than relying on
discounts, employers should provide incentives by extending the scope of
services to include post offer employment screening, drug testing and
maintaining work wellness. An appropriate fee schedule combined with
evidenced based guidelines will ensure quality health care for injured
workers, while reducing costs to employers.
5. Employers don't require quantitative measures of
results.
A crucial part of assessing the quality and effectiveness of any medical
program is the development of appropriate performance measures. There is
a surprising paucity of information on the results of care from WCMCOs.
A project by the Robert Wood Johnson Foundation Workers' Compensation
Health Initiative found that a number of barriers exist to introducing
standard performance measures in WCMCO, including the inadequacy of
patient data maintained by WCMCO and the low demand from purchasers for
the standard performance measurers.
Employers need to be proactive and insist that they receive:
- Qualifications of the physicians and nurse case managers: Are they
properly trained experts in the care of occupational injuries?
- Timely and appropriate care: are evidence-based guidelines
used?
- Outcomes: duration of disability, reduction in medical and indemnity
costs, return to work, employee satisfaction.
- Disability prevention: Is there a program to match fitness to job
requirements, post offer employment screening, etc.
WCMCOs were implemented to provide high-quality, cost-efficient service
to the injured employee and their employers. All too often the present
system, as structured, produces unintended bad results. Employers need
to proactively turn their attention to the way workers' compensation
organizations think about, implement and measure their
performance.
Frank Pennachio, CWCA, is a co-founder and director of curriculum of
the Institute of WorkComp Professionals, an organization that tests and
certifies insurance professionals to alert employers about the hidden
costs and overcharges in the workers' compensation insurance system. He
can be contacted at frank@workcompprofessionals.com.
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4. Are You Talking Too Much about
Safety?
By Carl and Deb Potter
Many company leaders and managers wonder, "Are we talking about safety
too much?" The answer: "No one but you knows."
How much "safety talk" is too much? Before you answer that question, you
need to realize that many employees and managers are overloaded with
communications these days. So when it comes to talking about safety, you
could be dealing with more of a social problem than a corporate
communication issue.
The fact is that the majority of company leaders want to talk about
safety. Injuries are a concern for everyone because they are emotional
triggers and they hurt everyone in the organization and at home. Nobody
wants to see another person hurt, and nobody wants to get hurt.
Consider this question: How can you talk about safety in such a way that
your employees don't get sick of hearing about it and therefore stop
listening?
Here's the answer: Stick to developing, maintaining and improving the
safety process.
This is a simple answer for a complex issue, but consider what it means
to focus on the process rather than on the emotions.
The Emotions of Safety
Too often people view and deal with safety in an emotional way.
Management gets frustrated when injuries occur and eventually it comes
out swinging the safety hammer. Pressure mounts and the managers step-up
their discipline (or corrective action).
Recently, a safety director for a large company described a situation
where an employee was fatally injured and two others experienced serious
injuries. For years, the safety director had tried to get management's
attention about needed improvements, but without success. Now everyone
in the company seems to be a safety expert; every executive has
the answer -- and everyone has a different
solution.
The Safety Process
In order to maintain safety at a level that prevents injuries, you first
have to work on dealing with the emotional issues so the focus is on
good decision-making. Realize that safety is both art and science and
needs to be treated as such.
The "art" is about dealing with people: establishing accountabilities,
holding people responsible and building trust. The "science" of safety
is about dealing with behavioral and technical processes. Hazard control
is an example of a process that includes both behavioral and technical
aspects.
The technical process of safety involves identifying the hazard, abating
or controlling it, engineering so it no longer exists or changing work
processes to include the use of protective or personal protective
equipment.
When a hazard control has been established, practiced and proven over
time, workers and leaders accept it as normal, and it becomes "common
sense" safety. Sometimes acceptance of a new rule or work practice seems
to take a while. And often, people don't even understand their own
resistance to the process.
The key, therefore, is to get employees involved. What would happen if
workers in your organization listed the hazards they face every day, and
then identified and quickly adopted a solution without emotion? An
organization's ability to function without emotion and make correct
decisions depends on the availability of internal leadership.
Use the following three steps to guide your workers and leaders to
discuss the "best practices" with regard to hazard control:
- Have every work team (usually no more than 20 people) meet and
facilitate a session by asking this question: "What hazards does our
team face each day that can cause injury to people and damage to
equipment?" Then list each hazard on the far left side of flip chart
paper. Your work team could easily fill up more than a dozen
sheets.
- Next, ask the team: "What rules and safe work practices do we use to
prevent injury to people and damage to equipment?" (If you have a
company safety book, use it for a resource.) Write the responses next
to each hazard on the list. Make sure everyone participates and
understands the controls.
- Finally, ask the team: "Which of these controls can I place a check
next to that we will always do?" Most of the time, the response will be
"all of them!" Discuss this last question at length with the team and
confirm that they understand that always using these controls will
provide a 99.9 percent probability that nobody gets hurt.
Take Action for a Safe Workplace
Sure, some people may think your company talks about safety too much,
and maybe they're right. Yet safety is an important topic that needs to
be discussed. Consider how you can get everyone involved in the
discussion and how you can encourage them to take action to ensure that
nobody gets hurt.
Carl Potter, CSP, CMC, and Deb Potter, Ph..D, CM,C work with
organizations that want to create an environment where nobody gets hurt.
As advocates of a zero-injury workplace, they are safety speakers,
authors, and consultants to industry. For information about their
programs and products, see www.potterandassociates.com
or contact them at Potter and Associates International Inc. at (800)
259-6209 or carl@potterandassociates.com.
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Here is a sneak peek at questions 3&4.
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d) As soon as the resistance to cutting increases
4. What is the best way to dispose of dull utility knife blades?
a) Throw directly in the trash
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c) Place in an approved Blade Disposal Container
d) Leave on the workbench for someone else to deal with
Take the quiz to day!
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5. Employers Must Post Injury/Illness
Summaries
OSHA reminded employers that beginning Feb. 1, they must compile a
summary of the total number of job-related injuries and illnesses that
occurred during 2007 and post this information in a common area in the
workplace.
>> More
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