Total systems approach cuts workers’ comp costs

Services for injured workers also improved

When lost work days and workers’ compensation costs began skyrocketing out of control at Sonoma Developmental Center in Eldridge, CA, hospital officials turned to the Team Care program for help. Now, after only one year in the program, lost work days have been slashed by 60% and temporary disability costs have fallen 30%.

"We were in dire straits and needed to take an aggressive approach," says Dean Percy, RN, director of health and safety at the 1,800-employee general acute care hospital and skilled nursing facility. "We’re very pleased with the results from a full year of implementation, and hope to see additional decreased costs in the future. We think it will take two to three years to show a huge improvement, but this is very good for the first year."

Lost work days fell from 6,124 in fiscal year 1996-1997 to 2,473 in fiscal year 1997-1998. Temporary disability costs went from $991,419 to $698,000 during the same period. Disabling injuries were reduced by 53%.

The program that helped Sonoma achieve those results takes a "systems process approach" to reducing workers’ compensation costs, says Tricia Day, president of Business Health Systems (BHS), the Santa Rosa, CA-based consulting firm that operates Team Care. "Most hospitals know they have a workers’ comp problem, but they don’t know where to begin. We put in place a workers’ comp system that is data-driven, yet customized to meet the needs of the organization’s culture."

Percy acknowledges that Team Care "is not a cookie-cutter type thing. They came in and looked at our numbers and at the policies and procedures we had in place. One of the problems we had was needing medical providers in the community who believed in the same philosophy as we do, such as early return to work, aggressive treatment, good communication between the doctor and myself and insurance adjusters, and a good understanding of the work environment and the type of work employees do here. [Team Care] helped us look for medical providers trained in occupational medicine and familiar with the workers’ compensation system in California."

Another part of the program focuses on supervisor training. Sonoma’s supervisors were taught to understand their roles "in the workers’ compensation arena," Percy explains, to help facilitate injured employees’ return to work.

Supervisors now are more accountable for injuries that occur in the areas they manage. Monthly injury reports are generated, tracking injuries in different work areas. The information allows providing a safe environment to become part of supervisors’ annual performance evaluations.

"We gave them more empowerment to take control over their work areas in training employees, moving equipment, and getting rid of older equipment," Percy says.

Take care of the caregiver’

In fact, as the result of supervisor and other employee feedback, Sonoma recently purchased more than $1 million worth of new patient-lifting equipment to reduce costly lower back injuries. The facility’s goal is to be a "no manual lift zone" within the next couple of years.

"We needed the new equipment. We needed to take care of the caregiver," he says. "That was our philosophy, to give them the tools they need to get the job done safely, both for the client and for the employee. Part of empowerment is to allow employees to say what they need to get the job done safely."

Percy says Team Care examined the hospital’s safety and injury prevention programs, evaluated trends, discovered the causes of injuries, and "helped us make changes within the organization instead of just putting out little fires."

Cynthia Hentley, PhD, developed Team Care (an acronym for Total Employee and Management Commitment, Accountability, Responsibility, and Empowerment) when she was director of health and safety at another California hospital. The program worked so well that the state adopted the concept, contracted with BHS to operate it, and hired Hentley as cost-containment project director, a position in which she oversees Team Care statewide. Five hospitals are currently participating, and the program is ready to be implemented nationally. Team Care has been nominated twice for the Harvard School of Business Innovation Award.

Hentley says the program takes a "holistic approach" that includes an organization’s culture, post-injury medical management, and injury prevention or loss control. (See checklist, p. 127.)

"This looks at the whole system and what the barriers are, and then develops processes to make the system flow better," she says.

For example, if post-injury medical management is a problem because physicians who are treating employees are not trained in occupational medicine or are not communicating well with employers or employees, Team Care finds well-trained doctors in the community and develops memoranda of understanding with them "so they will know what the expectations are," she explains. Expectations usually include such needs as providing immediate care for injured employees; being familiar enough with the work environment to return workers either on a modified transitional basis or on a limited basis with the intent of progressing to full duty within 45 working days; and communicating diagnoses and treatment plans to employees, employers, and insurance carriers.

Supervisor cooperation is another problem Team Care tackles. The program trains supervisors in how to work with employees on modified duty and how to modify tasks so people can come back to work.

The loss-control aspect of the program places responsibility on employees, supervisors, and the organization itself, Hentley says.

Happy supervisors = happy employees

"We develop teams to get people to work together as opposed to being at each others’ throats. When there is a lack of resources, people tend to get irritated, they get tense, they get upset and frustrated. If we have severe injuries, we have psychological programs that assist workers in coping with the stress or trauma of the injury. We also provide sensitivity training for supervisors to help them deal with their own stressors when resources get tight. We know that when we have happy supervisors, we have happy employees. We help them run a good team," she says.

Loss control also includes establishing computerized tracking programs to identify injury trends and generate reports of numbers of injuries, where in the hospital they’re occurring, and how much they cost.

"It’s a very specific analytical approach to looking at where the barriers are and identifying loss control programs to meet the needs," Hentley says. "Tracking programs go area by area, supervisor by supervisor, to see types of injuries, costs, and lost time associated with injuries. It’s the same as in any business — the driving factor is the cost."

Using the information generated by computerized tracking, Team Care shows hospital managers how they can reduce injuries. One way is by helping them to set up safety committees to identify needs and solutions in different areas of the hospital.

"We find that when people come up with their own solutions and recommendations, they tend to buy into them better," Hentley notes.

While individual hospitals’ needs and problems vary, Hentley says Team Care can reduce lost work days by at least 60% within the first 18 months. Total workers’ compensation costs generally can be decreased 60% or 70%.

"This systems approach works because it brings in the insurance carrier, the treater, the employer, the administration, and the injured employee all working together so that everybody is on the same page and knows what the expectations are. That’s what I see as the missing link," she says. "In some hospitals, nobody knows what’s going on. The situation is so complex, but people aren’t communicating with each other. We want everyone to know exactly what is going on. The intent is to help the employer, the insurance company, and the medical profession get a good approach to workers’ compensation because it’s always been a thorn in everybody’s side."

BHS president Day says Team Care focuses on hospitals because of the need for effective workers’ compensation management in a high-injury industry.

"Health care has one of the highest injury and illness rates of any type of industry. It’s as hazardous as doing construction or other types of work that people traditionally think of as dangerous," she says.

Also, health care workers tend to accept injury and illness as part of the job of caring for people, and they sometimes forget to take care of themselves, she adds.

"We look at the psychosocial makeup of an organization, what we call its culture. We look at how morale affects injuries, at job engagement and job burnout, how you keep people interested, motivated, and creative in their job. Sometimes people are looking for a way out with workers’ comp," she says. "They’ve just had enough; it’s a very physically, emotionally, and spiritually draining job. Negativity in the workplace effects injuries. If people have good morale and are working as a team, injury rates tend to be lower."

Day notes that Team Care brings in medical doctors, psychologists, physical therapists, organizational development experts, occupational health nurses, and management information specialists as needed to help hospitals lower workers’ comp costs.

"Hospitals are now looking at where all the costs are and how to reduce them, and injuries is one of the big areas they are looking at," Day says. "The key is a comprehensive approach — sifting through all the information and data, finding the risks, what is costing a lot of money, and then plugging the holes. These things take time. They didn’t happen overnight, and they’re not going to go away overnight."

[Editor’s note: For more information on using Team Care at your hospital, contact Business Health Systems, 1738 Willowside Road, Santa Rosa, CA 95401. Telephone: (707) 528-1830. Fax: (707) 578-1292.]