Internal case management program gets injured employees back to work

Database helps track alternative jobs 

An internal case management system for hospital employees who are injured on the job has reduced costs and increased return to work for Allina Hospitals and Clinics, based in Minneapolis.

The health system’s disability case management program received the 2003 Quality Leadership Award from the Certification of Disability Management Specialists Commission for its disability case management program.

"The system is meant to help injured employees continue to work. Without these case managers, some employees could fall through the cracks and lose more time from work. It would be a lot more costly from a workers’ compensation standpoint," says Marsha Studer, MPH, corporate safety and health director for Allina Health System.

Allina Hospitals and Clinics operates 11 hospitals and 65 clinics staffed by more than 23,000 employees.

The health system has on-site occupational medicine clinics staffed by nurse practitioners and occupational medicine physicians at its large hospitals, allowing injured workers to get care in minutes for injuries or exposures to potentially hazardous situations. The clinics also provide vaccinations and tests, such as annual tuberculosis screenings.

Accommodating workers via alternative jobs 

The hospital’s internal return-to-work program centers around an internal placement program that requires managers to accommodate employees with alternative assignments.

The managers enter any special projects they need help with or any opportunities for alternative work into an electronic database, giving the case managers quick access to jobs that are available.

"When employees have work injuries and can’t do their regular jobs, we can bring them back to work, whether it’s light duty in their department, or other work in the hospital that can keep them on the job," says David Dubovich, one of the health system’s three disabilities specialists.

Dubovich and his colleagues have offices in the occupation medical clinics, making them easily accessible to injured employees.

After the employees are treated, the internal disability case managers evaluate the employees for vocational and medical issues, help them navigate the complex claims system, and help them return to work.

Dubovich says he develops a rapport with the employee, often spotting barriers to effective return to work, such as relationships that are not working, or psychological stress that could interfere with the employee’s return to work.

He may refer an injured employee who has mental stress to other resources, including the hospital’s internal or telephonic employee assistance program for a referral to a counselor.

"An injury at work can be traumatic for the employee as it is disruptive of their normal routines at work and at home. When I talk to them, they may disclose other things that are going on at work or problems with their managers. I encourage them to call our employee assistance program for referral to a counselor. I assure them that the counseling services are confidential and voluntary," Dubovich says.

If an employee can’t return to his or her regular job within a few days of injury, that person starts to work on alternative assignments. Dubovich acts as a liaison between the injured employee and his or her manager, encouraging them to communicate with each other and keeping the manager informed of the employee’s return-to-work status.

"The managers appreciate having an outside party help them understand what’s going on and to help create a plan of action to get the employee back to work," he says.

When Dubovich meets with an injured employee, he assesses the vocational status, such as transferable skills, career interests, functional abilities, work restrictions, and the hours typically worked and tries to find an appropriate alternative job.

Once the employees are on the job, the case managers monitor their follow-up appointments with their physician and find out how they are progressing medically and help in facilitating communication with the claims staff.

Smoothing out the return to work 

When the employees are ready to take on some of their regular duties, the case manager develops a return-to-work plan that may include placing them in their regular job for a reduced number of hours and gradually adding duties each week to build up their capacity for more demanding work.

"We want the employee to have a successful return-to-work experience and to be able to work safely without further injury," Dubovich says.

The case managers work closely with the organization’s internal placement specialists to accommodate patients who can’t return to their regular job. "Sometimes when medical restrictions become permanent, the employee is not able to return to his regular job. Then our goal is to help the employee find a job in the system that puts their knowledge and expertise to work," he adds.

Sometimes employees who can’t return to their regular job are hired permanently by the department where they were assigned to light duty.

In other cases, the case managers and internal placement specialist coordinate training for employees who might be able to move into a position that doesn’t involve physical work.

For instance, the hospital offers seminars on communication skills, computer skills, and medical terminology, enabling employees to work in the call center or other sedentary positions.

They work with the employees on safety issues in their workplace in an effort to prevent future injuries.

For instance, if an employee comes in with early warning signs of tendonitis, the case manager may send him or her for an ergonomic evaluation and suggest ways to reduce the symptoms.

Dubovich’s cases range in length from two weeks to several years if a patient has several surgeries and multiple attempts to return to work. The average length is about six months.

He works with complex cases on a daily basis, otherwise touching base at least weekly with his active cases. He typically handles about 100 cases a year.

Injuries catch up with older workers 

The bulk of his cases are employees with neck, back, and shoulder injuries, something he attributes to an aging work force suffering from the cumulative effect of physically demanding work and a trend toward more obese patients who are difficult to lift.

"The hospital’s internal case management program was begun in 1985 when a nurse with case management skills was injured.

"We were looking for a placement for her and decided to ask her to help with return-to-work support and coordination. That was the beginning of our case management program," Studer explains.

The current program is staffed with case managers with a vocational rehabilitation background, she notes.

"They are familiar with all kinds of different jobs and work accommodations. They are able to match the employees with jobs suited to their skills if they need alternative types of work," Studer adds.