Taking a LEAP lowers WC costs

Fewer CNA injuries with lifts

It's a common disconnect: An employee at home, healing from an injury, feels increasingly distant from work. As time passes, the chance of that employee returning to work drops. The result: high workers' compensation costs.

To reverse a spike in workers' compensation, Novant Health in Winston Salem, NC, restructured its response to injured employees and improved their follow-up. The result: Workers' compensation costs remained flat while the hospital system's staff grew from 10,000 to 17,000 employees.

They also took a LEAP — with a Lift, Ergo-nomics, And Post-offer testing program that focused on preventing patient-handling injuries.

Fewer injuries, less lost time

Changing the workers' compensation system, as well as implementing a safe patient-handling program and functional assessment of new employees, resulted in fewer serious injuries and less lost time. The number of lost workdays among employees declined from about 200 per month to about 20 to 30 per month, says Kathy Avery, RN, BSN, corporate director for employee health, workman's compensation, and family leave. The number of restricted days dropped from about 1,350 to about 150, she reports.

Novant Health accomplished its goals by putting a focus on the employees' needs. "One of the biggest successes was getting the employees tied back in with the [case management] system. They feel more involved," Avery says.

The hospital system also identified light-duty jobs that injured employees can safely perform, and almost all employees (98%) are able to return to work in some capacity, says workers' compensation manager Angel Rich. "If you can keep a person productive, it's better overall, emotionally, financially, and physically," she says.

EH nurses are WC liaisons

Workers' compensation costs were skyrocketing when Avery took a closer look in 2005. The health system had outsourced the case management of injured employees. Employee health did not get involved until the employees returned to work with restrictions.

Avery discovered that there was not much contact with employees while they were out of work. "The employee did not believe that anybody cared about them," she says. "Nobody was calling them at home to check on them."

As a result, the rate of return to work after six months was low. "We thought we could impact that by assigning [employee health] nurses to cases that were [ongoing]," she says.

Now, employees come to employee health when they are injured and immediately connect with a nurse liaison. "The nurse follows them through their experience," reports Avery. "They talk to them about doctors' appointments and physical therapy appointments. Now they have a nurse liaison who knows their faces and their names."

Employee health hired a physician assistant to handle workers' compensation cases. Providing swift care to employees helps reduce overall medical costs, Avery says.

"One of our goals to expedite their care, so they weren't sitting in a queue waiting five or six weeks for physical therapy," she says. "If they needed it, we wanted to get them started the next day."

Novant assigned workers' compensation cases to a single physical therapist. "They make our employees a priority whenever possible," she says. The new system streamlines care. "It's really the best thing for the employee," she says.

Lift equipment is essential

Reining in workers' compensation costs would require more than better case management. Novant needed to reduce the number of cases. With a comprehensive approach to injury prevention, Novant reduced its patient-handling injuries from 65 in 2003 to just eight last year.

Avery analyzed the injuries and discovered that lifts and transfers were causing microtraumas and repetitive motion injuries. CNAs (certified nursing assistants) were the most likely to suffer an injury. About half the injuries occurred in the first six months after employees were hired.

She made a case for the purchase of new lifts and patient transfer devices, and Novant took the LEAP. Employees helped evaluate the new equipment in a two-day fair, and Novant placed an emphasis on lifts that were easy to use and had good maintenance records.

Prevention pays back

Buying a sufficient number of lifts also was important, and the investment was substantial. One of Novant's hospitals spent $500,000 on lift and transfer devices. But with injuries that could cost as much as $200,000, "preventing one or two back injuries would pay for the equipment," she says.

Meanwhile, post-offer testing ensured that employees had enough basic physical agility to perform the job, Avery says. "If you're not physically conditioned to do the job, you're at higher risk of being injured," she says.

Avery conducted a job demands analysis to determine the physical requirements in bending and standing, lifting, trunk rotation, and gripping and pinching. For example, even with the use of mechanical lifts, the CNA position required the ability to lift 30 pounds from floor to waist.

Many steps to a leap

Novant also has implemented a wellness program that provides nutrition and smoking cessation classes, walking and stair-climbing, and fitness center discounts. Each part of the LEAP program has contributed to Novant's success in reducing workers' compensation costs, says Rich.

"The reduction we've seen in lost duty days would not have happened if we hadn't made all those steps and processes," she says.