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Turnaround in EH produces cost-savings
In-house programs reduce injuries, claims
Workers' compensation claims were painfully high when Bonnie Johnson took over as director of employee health at Citrus Valley Health Partners in West Covina, CA, a system of three acute-care hospitals, a hospice facility, and about 3,200 employees that is 25 miles east of Los Angeles.
She knew it would take an investment in injury prevention, a change in mindset, and persistence to turn around the losses. But Johnson never doubted that it would happen. Now, about eight years later, the health system has reduced its ergonomic-related claims from about $500,000 to just more than $100,000. In 2005, the health system had 184 lost workdays due to injury; in 2008, there were just 67.
The key, says Johnson, was the recognition by hospital administration that employee health could be a valuable service. "We're not a moneymaker, but you can be a money-saver - which equates to a moneymaker," she says. "An injury, and the costs associated with it, impacts the whole organization."
Johnson's first step was to gain control over costs. She ended the outsourcing of pre-placement exams and hired a nurse practitioner. The health system was paying about $75,000 for the outsourced exams - enough money to cover the nurse practitioner's salary. In fact, the health system would get more for its money, including exams that were more complete and other tasks such as exposure control and first-aid treatment for work-related injuries.
The nurse practitioner was able to develop relationships and respond to employees' needs. "No one is going to care about the staff that you hire more than you do," Johnson says.
Johnson, who has a background in risk management, also learned that the health system didn't really know much about the injuries that led to the workers' compensation claims. She gathered data on sprains and strains and analyzed it by hand. She found that the hospital was spending $230,000 on patient handling injuries a year.
In 2004, Johnson hired a part-time ergonomist (whose job has since expanded to a full-time position). She and ergonomics coordinator Dora Shaieb, MPT, CEAS, meet monthly to review injuries and look for trends. They seek opportunities to avoid claims by correcting problems before they cause injury.
With help from a consultant from the hospital's worker's compensation carrier, Traveler's Insurance, Shaieb went from floor to floor, assessed ergonomic needs, and sought input from staff. It took a year and a half just for the evaluation.
"If you don't get input from staff and they don't have buy-in, you're not going to be as successful," Johnson says.
The health system invested $180,000 in patient handling equipment. Meanwhile, Johnson and Shaieb discovered that many of the patient handling injuries occurred among employees who had less than a year's experience. They beefed up the new employee orientation to spend more time with the lift equipment.
Citrus Valley Health Partners doesn't have a lot of resources. The health system buys equipment incrementally. When necessary, the system makes an investment in safety because it pays off. For example, the health system purchased slip-resistant shoes for dietary and housekeeping employees for $10,000. Claims for injuries related to slips and falls declined from about $200,000 in 2005 to just $1,600 in 2008.
A multidisciplinary team conducts safety rounds, including Shaieb and representatives from engineering, safety, infection control, environmental services, and security. Johnson and Shaieb try to emphasize the positive as they visit hospital departments to observe safety behaviors, but they also want to identify problem areas. "We're out in the trenches. We don't just sit into our offices," Johnson says.
For example, Shaieb analyzed the office workstations and spoke to employees about wrist or shoulder pain. In a five-year period, strains, sprains, carpal tunnel syndrome and similar injuries among health care and office workers cost the health system more than $10 million. The health system purchased new keyboards and chairs to accommodate workers. A $200 keyboard is far cheaper than a claim for carpal tunnel syndrome, which can cost $6,000 to $20,000, says Johnson.
In a new initiative, they plan to ask nurses to observe each other as they perform repositioning and lifting tasks. Johnson is developing tip sheets to educate nurses and structure these observations. (See sample, above.) Both the one conducting the observation and the employee who is correctly using patient handling equipment can receive a ticket for a raffle of small prizes.
This is a program of "behavior-based safety," which relies not just on new equipment but on the active participation of employees in working toward safety goals. "We want peers to watch peers do their jobs and give them [feedback]," says Shaieb. "We think that will help improve the [compliance with] safe patient handling and help with every aspect of safety."
The hands-on approach in employee health has created a new culture of safety at the three-hospital system. Johnson conducts an employee satisfaction survey to get feedback on the employee health services. But one resounding vote of confidence came when employees selected Shaieb as "nurse of the year." She actually isn't even a nurse; she's a physical therapist/ergonomist.
"It all equates to good customer service, good procedures, and good policies," says Johnson. "If you have those things in place, people will do what they need to do."
"One of our goals is just to let them know we care, that we want them to be healthy," adds Shaieb.
There's isn't money to spend on a fancy wellness program, but the hospital began offering healthy options in the cafeteria and classes for yoga, smoking cessation, and weight loss. Johnson has even brought free chair massages to their annual wellness fairs.
In the end, better employee health will produce more effective and productive employees, says Johnson. "Hopefully, the care we give to our customers, they will give to our patients," she says.