GE reduces disability time, improves morale with case managers for all injuries
GE reduces disability time, improves morale with case managers for all injuries
Program wins ACOEM award
Case management is a concept that has proven its value to the health care community, but some companies take the idea further than others.
General Electric Power Systems (GEPS) in Schenectady, NY, for example, found that case managers can make a huge difference in an overall occupational health program as long as they are well-informed about the goals of not only the injured worker, but also the employer.
Effective case management requires the case manager to be fully aware of the company’s goals, says Marybeth Stevens, MS, CCM, CBMSC, CRC, program manager for disability for GEPS. It is not enough that they be familiar with the clinical goals of the program, or even that they be familiar with the actual work processes.
That kind of knowledge also is important, Stevens adds, but she stresses that the case managers must be familiar with the employer’s business plan.
"You have to keep the employee customer as well as the business customer in mind," she says. "To get buy-in from management, you have to show that your case managers are operating with an understanding of the overall business goals and helping to achieve them. That’s going to get the attention of management, and there doesn’t have to be any conflict with helping the employee."
Program wins ACOEM award
The American College of Occupational and Environmental Medicine (ACOEM) in Arlington Heights, IL, named GEPS one of three national winners in its 2000 Corporate Health Achieve-ment Awards competition. GEPS is a leading supplier of power generation technology, service, and energy management systems, and is among the fastest-growing of General Electric’s 10 major businesses.
The company has 22,000 employees in 12 large manufacturing locations, 64 inspection and service shops, and 130 sales offices around the world.
In judging the awards, a team of occupational medicine physicians studied extensive documentation on GEPS’ health and safety programs, then completed the final examination and review process during an on-site visit.
The company’s disability management program was one of the GEPS initiatives singled out by the examiners as exemplary. They praised the program for its integrated case management of both on- and off-the-job injuries and illnesses. These are some key features of the program:
• on-site clinics with nurses and physicians prepared to treat sick or hurt employees, or agreements with qualified local occupational medicine clinics to provide such treatment;
• a team of eight case managers who closely oversee any ill or injured employees, guiding them through their care plans and working with clinics, physicians, production, the union, and management to find appropriate tasks when employees return to work;
• ongoing tracking of program effectiveness through scorecard assessments of all clinics’ performances and a database to track disability and rehabilitation;
• "First Response" program staffed by volunteers trained in such areas as cardiopulmonary resuscitation, first aid, bloodborne pathogen control, coping with post-traumatic stress, and psychiatric emergencies;
• excellent relationships with local emergency response units and hospitals.
A recent survey of the program showed that 93% of GEPS employees rated it as good or excellent. Included among the results achieved since 1995 are reductions in first-time medical claims from 1,163 to 557 (52%), lost-time events from 593 to 285 (52%), and incurred costs from $14.5 million to $5 million (66%). In addition, the company’s workers’ compensation premium has dropped by $4 million over the past two years, and workers’ compensation days away from work have fallen by 38%.
Supported by union, management, employees
The case management program was begun in June 1995, but Stevens says the benefits didn’t start accumulating until later. Some of the strongest parts of the program were developed only after GEPS had started implementing them and learned what worked well and what didn’t.
"It took time to see results," she says. "We had to learn to work with the business leaders and the union to build trust and generate a culture change. We wanted to send the message that we care for the employees and are going to facilitate a safe, effective return to work."
One of the first goals was to get the union’s support, Stevens says. Once GEPS started talking about a case management program, the union had a few ideas about how it might be structured.
"The union brought it to our attention that they wanted to partner with us in helping to assure that this would be real work in the modified or transitional work arrangements, not make work," Stevens says. "They also wanted us to apply the program to all of the injuries and illnesses that the workers might encounter, not just job-related injuries and illnesses. That was a big plus to them."
GEPS has eight case managers, which it calls "care managers," at the company’s six work sites around the country. They serve as the worker’s primary contact person within the workplace, and they personally oversee the care provided with the goal of ensuring good clinical care and a speedy return to work.
If the health care provider determines that the employee can return to work in a modified position, or in a transitional job of limited duration, the case manager investigates the availability of such a position. For such modified or transitional jobs, GEPS aims for a duration of six to eight weeks.
The key to doing that part of the job well, Stevens says, is the case managers’ knowledge of the workplace. They understand the GEPS product thoroughly and actually are out on the shop floor for much of the day.
"The essential part of their workday is to be out there with our people," she says. "These are not telephone-based office dwellers."
Stevens says the comprehensive nature of the program is one of its strongest points. Rather than addressing only on-the-job injuries and illnesses, the way many occupational health and case management programs do, GEPS applies its case management to any injury or illness suffered by an employee. While that certainly increases the case load and costs, Stevens says the expense is worth it.
By addressing all injuries and illnesses, GEPS’s case management program focuses on getting workers back on the job. The origin of the disability may be important in a number of ways, but when it comes to reducing days off of work, the source of the injury or illness is meaningless, she says.
"It really doesn’t matter where you hurt your back," Stevens says. "We’ll help you whether you hurt it playing softball on the weekend or here on the job. People often are chasing just one part of the continuum, the workers’ comp injuries and illnesses, when that’s only one component of getting people back to work."
Stevens says that for most companies, two-thirds of workers’ days away from work are driven by nonwork-related injuries and illnesses. That figure is a surprise to many occupational health providers and employers, she says. In addition to improving the return-to-work statistics, a comprehensive approach to case management often can strengthen the way the medical community views the program.
"They appreciate the fact that you’re working on the employee’s overall health, rather than just singling out the one injury that falls under your workers’ comp program," she says. "They see that you have more of a complete approach."
Other initiatives round out program
In addition to the case management program, ACOEM recognized the GEPS occupational health program for these other components:
• An international travel medicine program with intranet support, a structured, company-wide approach that offers information to traveling employees through myriad avenues — including a Web site, instructional videos, CD-ROMs, a travel kit, and a toll-free telephone MedReady advice line.
GEPS identifies employees who will be traveling when they’re hired and includes them in an orientation program, and provides each training class of field engineers with travel briefings and immunization clinics. The program also offers off-site client services, and in 1999 supplied inoculations, medical advice, and consultations at 12 global meetings to more than 1,100 employees.
Employee awareness of the need for immunizations has soared from 46% prior to the program’s inception to 97%.
• A well-developed safety tracking system, a key component of GEPS’ program emphasizing personal accountability, high employee involvement, and careful documentation.
Through computer monitors on the plant floor, the company’s Web-based material safety data sheet tracking system gives all workers immediate access to critical chemical information, facility incident reports, and training records, and helps to ensure that incident investigations are followed to completion.
As a result of the tracking system and other safety initiatives, accidents at GEPS have been reduced 73% over five years to a current rate of 3.4 (less than half of the industry average). The lost-time rate has been reduced 75%, and ergonomic illnesses have been reduced by 50%.
A highly cooperative union-management safety relationship has been firmly established. In addition, every domestic GEPS site has initiated the Occupational Safety and Health Administration Voluntary Protection Program, with six already designated as Star sites (the highest certified sites in the program) and 10 more anticipating earning the designation by year end.
• The personal protective equipment (PPE) program, which has successfully created a change in company culture to reverse low PPE use, with employee involvement again playing a key role.
The program requires that supervisors, engineers, and everyone who visits the plant floor use PPE, demonstrating cooperation from business leadership. Employees are included in the selection of PPE for their locations and may often choose from more than one protective device, minimizing personal resistance.
All employees are trained on how PPE can help them avoid life-changing accidents by watching films and hearing speakers recount the physical and emotional consequences they suffered by failing to do so. Moreover, a reward and discipline system helps encourage compliance with PPE requirements by providing free lunches and recognition awards to those with the highest utilization rates.
Results of this program have been highly positive, with injuries caused by lack of PPE use reduced by 70, and current PPE use averaging between 95% and 100%.
In addition, ACOEM noted GEPS’s use of data analysis to improve resource utilization within company medical programs, which has produced almost $8 million in cost savings and close to $11 million in cost avoidance since 1997, the company’s strong emergency response program, and GEPS’ wellness activities.
In particular, the flu immunization program provided more than 8,000 free flu vaccines in 1999. Another wellness activity is the Heart Power program to help employees reduce their risk for heart disease.
The other 2000 CHAA national winners were Dow Chemical Company and Sherman Health Systems. In addition, Brookhaven National Laboratory and Idaho National Engineering & Environmental Laboratory received Model Program Awards.
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