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Performance improvement approach yields savings on health screenings
Changing the process isn’t always easy
Figuring out how to save money is a lot easier than actually doing it. That is the lesson that Delynn Lamott, RN, MS, COHN-S, learned when she went to work for a small community hospital in Michigan. She thought her supervisors would be thrilled when she told them they could save more than $150 per person screened in the pre-placement process for new hires.
They weren’t. The head of human resources and the hospital’s vice president of legal affairs were concerned about liability if they dropped pre-placement tests and thus failed to detect a new employee’s illness or injury. Yet in reviewing the process, she saw tests that were unnecessary or others that could require costly follow-up or actually add to the hospital’s liability.
"I couldn’t get anyone to listen to me," says Lamott, who is presenting her experience at the annual conference of the Association of Occupational Health Professionals (AOHP) in Healthcare in October in San Diego. Lamott is an assistant professor in the nursing department of the University of St. Francis in Fort Wayne, IN. "I thought, I have to get this changed somehow.’"
Her experience provides both a lesson in streamlining the pre-placement process — and in how to change longstanding but flawed employee health practices.
Change is difficult; the pre-placement process at her hospital had been in place for years. But Lamott ultimately was successful when she approached it like a performance improvement project: gathering data and seeking collaboration.
Lamott first reviewed all the elements of the pre-placement health screening and considered their relevance. "You want to be careful that you’re only dealing with [health] information that’s applicable to the hiring process," she says.
For example, the hospital’s newly hired employees all received a physical exam, including complete blood count, hematocrit, and urinalysis along with a back X-ray. Yet in most cases, the physicals didn’t reveal anything that related to fitness for duty, she says. The urinalysis may show if a patient has a bladder infection — but that’s a private health matter. "What are we supposed to do with that?" says Lamott. "It has nothing to do with the hiring process."
Except in rare cases, the back X-ray also is irrelevant, she says. "A back X-ray isn’t going to tell us if you’re fit to lift 20, 30, or 40 pounds."
Lamott also reviewed the alcohol- and drug-screening policy. Alcohol is eliminated quickly by the body, so someone would actually have to be drunk within five hours of the screening to register positive. Some other substances, such as cocaine, also are eliminated quickly and are unlikely to come out positive — unless the testing is for cause, she says.
Finding out what works for others
Lamott had some strong ideas about how she would recreate the pre-placement screening. But to bolster her argument, she polled 10 area hospitals.
"Everyone was doing something a little bit differently," she says. "The only other place doing a physical was using [medical] residents and physician assistants or nurse practitioners. It didn’t cost them anything, and it was a learning experience for the residents. Most of them were doing drug screening. Nobody was doing a urinalysis, complete blood count, or hematocrit. I don’t think anyone was doing a back X-ray, either."
The information from other hospitals strengthened her case. "That gave me a lot of validity," she says.
Lamott then drafted a proposal, with the purpose listed at the top. She could streamline the pre-placement process, make it more effective — and save money. "I took each item I wanted to eliminate and gave a rationale for why. I outlined the current process: how long it takes, how much it costs," she says.
She also included comments from employee satisfaction surveys that stated how much they disliked the process. The employees said they found the pre-placement process to be inefficient and the physicals "worthless."
Here are some changes she proposed:
• No more physician-conducted physical exams.
Lamott revamped the health questionnaire to pick up on prior work injuries or back problems. They ask about latex allergy and risk factors for latex allergy, such as allergy to certain foods, items containing latex, or past incidences of latex allergy. "Ask if they have any reason they couldn’t do the job they were hired for," she says.
"Ask if they had any past work injuries. Studies have shown if you’ve had a work injury before, you’re more likely to have another work injury over someone who’s never had one." That wouldn’t be a reason not to hire someone but might be information you would share with a manager, she says.
• No more back X-rays.
An employee health nurse screens new hires for potential back problems with a simple evaluation, such as asking them to touch their toes and perform simple lifting exercises. Any questionable cases are referred to a physical therapist for a complete evaluation.
• Streamlined drug screening.
Lamott scrutinized the list and tests for those drugs, such as marijuana, that stay in the body for a long period of time. Eliminating alcohol screening, which was unlikely to produce a positive result, saved nearly $50 per person.
• Employee health-administered color vision testing.
The department purchased a book to conduct an Ishihara test for those employees who need to be able to distinguish colors as part of their job duties.
The result: Pre-placement screenings that once cost $227 per person and took 4½ hours now cost about $48 and take less than two hours.
Lamott drafted that comparison on her proposal, along with the information she received from the other hospitals. Then she enlisted the help of a highly respected physician. The medical director of the emergency department gave her a signed endorsement.
She placed the documents in a binder and left it for the vice president of legal affairs and the human resources director. The proposal was approved literally overnight.
"I told them 100 times, and no one listened. But when I put it in this format, they listened," she says.
Her advice: "You have to give people concrete [material] that they can look at. You need to ally yourself with someone who has influence and power. You have to have data to back up and support what you’re proposing."
[Editor’s note: The AOHP conference will be held in San Diego Oct. 8-11. For more information, go to the web site: www.aohp.org for an on-line brochure and registration information. Or contact AOHP at 500 Commonwealth Drive, Warrendale, PA 15086-7513. Telephone: (800) 362-4347.]
Special Report: A bottom line strategy for EHPs
Does your hospital administration view employee health as a cost center? You may not bill for your services, but you have a tremendous potential to create cost savings. In this issue, we present ideas and strategies for streamlining your processes, reducing workers’ compensation claims, and preventing injuries. The result could be hundreds of thousands of dollars in savings — more than enough to pay for your investment in injury prevention.