Investing in safety management saves $1.2 million for private duty agency

How to develop your own comprehensive safety program

Four years ago, faced with a whopping 321% increase in workers’ compensation insurance premiums and an incredible 1,100% rise in incurred claims costs, SNI Home Care in Flourtown, PA, took dramatic steps to reign-in program expenses and curb work-related injuries. One of the main components of this effort was an aggressive safety management program.

The primarily private duty company’s aggressive action paid off. Currently, its incurred claim costs are 85% less than their 1995 high, and work-related injuries are one-half of their 1995 high.

That translates to a savings of $1.2 million in premium outlays and direct claims expense reduction over three years. And the cost was less than 10% of that savings.

Several factors caused SNI’s initial negative experience, says Dorothy Morasco, director of human resources. Started as a supplemental staffing agency with only independent contractor caregivers, the company had virtually no work-related claims during its first 10 years of operation. In 1990, it began providing home care and also landed contracts with three area aging care agencies. Suddenly, the company employed nearly 75 home health aides, among the most injury-prone home care workers (see August, 1997 Private Duty Homecare, p. 91), and its workers’ compensation claims mushroomed over a two-year period.

How do you combat a negative insurance environment?

Already employing higher premiums because of increased claims activity, SNI’s insurer offered little proactive safety management support. Additionally, at that time, Pennsylvania had some of the most employer-adverse workers’ compensation laws in the United States, limiting SNI’s insurance options and making its rates, along with other Pennsylvania-based employers, higher still.

SNI’s experience is typical of home care providers, says Anthony Ellis, manager of safety management for Argonaut Insurance in Bala Cynwyd, PA. Insurers take a negative view of the industry’s high turnover, low controls, and potentially large claims, leaving agencies with few insurance options. Many participate in state funds, often the insurer of last resort, and those agencies receive little help controlling costs. The adverse insurance environment, combined with providers’ misconceptions about safety management, lead them to believe they have limited influence over accident prevention.

Morasco’s search for reduced costs and injuries convinced her safety was something "we could control but just weren’t paying attention to." SNI partnered with Argonaut Insurance and implemented an aggressive safety program combined with a higher deductible to decrease costs. Their plan, implemented over three years, combines many elements, including the following:

Hold management accountable.

Management accountability is the cornerstone of SNI’s safety program. Ellis says it is the single most important factor in improving a company’s safety record. He adds that managers’ performance appraisals should include safety parameters just like other supervisory functions, with specific measurable goals.

SNI tracks injuries by home care team and reviews results with front-line managers. The managers, working with SNI’s safety committee, develop corrective action plans for common injuries. Morasco is now planning an incentive program in which, for example, a home care team that remains injury-free for a year will be rewarded.

Educate all staff.

Accountability and education go hand-in-hand, says Ellis. "Managers must be given tools to accomplish their goals and improve results." SNI managers attend two Supervisory Training in Accident Reduction Techniques (START) sessions. The first emphasizes management’s role in creating and maintaining a companywide safety culture. The second addresses major accident causes and behavior modification measures to reduce those factors. After START training, managers routinely observe staff and intervene in potentially unsafe behaviors.

Morasco sees positive results from both the general safety education and behavior modification training. She recalls a past incident when a field staff member reported experiencing a slight back pull and was initially asked whether she could see more patients. Now, in a similar situation, managers and schedulers would immediately reassign the employee’s cases and direct her to a company physician.

Behavior modification essential

Because it depends on direct observation and feedback, behavior modification in home care presents unique — but not unconquerable — challenges, says Ellis. He acknowledges that home care managers cannot supervise as intensely as their institutional counterparts, but adds they "can be there more often." He suggests managers focus on a few behaviors, determine who will conduct field observations, and hold staff to a plan. Morasco notes behavior modification does not only occur in the field. For example, a manager who asks a harried field staff member rushing off to his next case to slow down may forestall an accident.

Education starts with managers and spreads to all employees. As SNI implemented its safety program, rank-and-file employees attended a modified START session and viewed and were tested on four safety videos covering back safety, defensive driving, safety in the home, and general personal safety. Education continues with annual mandatory back safety inservices and other periodic programs such as office-based safety and violence in the workplace.

SNI also educates new employees about safety. According to Morasco, this sets the tone and "lets orientees know you pay attention to safety." It discourages the few individuals with fraudulent motives and gives others a sense of the company’s concern. New staff learn of both their and SNI’s workers’ compensation rights and view and are tested on the same four safety videos seen by existing employees. Other safety issues are also reviewed, such as office safety.

Discriminately employ.

Because work-related injuries follow employees to new employers — and fraudulent individuals look for large (more than 200 employees) or safety-inattentive companies — Ellis advises careful interviewing and thorough reference checks. He estimates only 2% to 3% of all claims are fraudulent. However, they account for 25% of claim dollars. So a poor hiring decision can have significant consequences.

Interviews should focus on skills, knowledge, and attitude. Ellis recommends asking applicants "not what they did, but how" they performed previous jobs. Their answers indicate what they thought was important about their jobs and may clue the hiring manager to potential problems.

Establish a safety committee.

SNI established its safety committee early to obtain employee buy-in, oversee other safety initiatives, and establish companywide safety goals such as reducing work-related injuries by 25% annually. The committee members — two home health aides, two RNs, two physical therapists, and two office-based employees — meet monthly and conduct safety case conferences, evaluating contributing factors and actions which may have avoided injuries. The group also recommends topics for SNI’s safety newsletter and implements other safety changes. For example, it is now creating a safety evaluation form which will be included in each employee’s annual evaluation.

Routinely communicate safety issues.

SNI continually highlights safety issues through various publications and notices. Its bi-monthly newsletter, Safety First, addresses such topics as office safety and appropriate lifting techniques. Employees also periodically receive special notices. Examples include a holiday safety pamphlet that covered home, mall, office, and home care safety tips, and a vehicle safety mailer. The idea, says Morasco, is for employees to "incorporate safety into their lives" not just their time on SNI’s clock.

Support injured workers’ return to work.

SNI encourages injured workers’ early return to work. With physician clearance, they initially fill office-based light duty positions, performing numerous support functions while receiving full wages. Morasco says this "psychological reattachment to the work place" is crucial. Without it, employees return to work more slowly and less successfully.

Once workers are ready for full duty, they meet one-on-one with a company physical therapist to review lifting and transfer techniques. The physical therapist also closely observes the worker as they return to work and increase their case load or normal job functions.

According to Ellis, SNI has gone "above and beyond" to achieve its safety goals. Many companies only implement the top three-to-five recommended safety measures, whereas SNI executed nearly all Argonaut’s recommendations. For that reason, and its on-going safety improvement commitment, Argonaut recently nominated SNI for the Pennsylvania Governor’s Award for Safety Excellence.

SNI’s program implementation required a lot of time and resources, but Morasco says the outcome was well worth the effort. However, she warns not to expect immediate results. SNI actually suffered its worst claims year after it began program implementation, at least in part because staff were more educated and were more likely to report an injury. Ellis says providers should not expect any results for three to six months, adding that it takes time for training to fully impact the organization. Safety management, he notes, is "the school of gradual gains."