Risk management program saves firm $5 million

New hires assessed, then job tasks customized

A unique risk assessment and management program targeting upper extremity musculoskeletal disorders (MSDs) at a major Wichita, KS, airplane manufacturing company has saved that company $5 million in direct costs in four years. Workers compensation costs decreased 16%, 3%, 24%, and 12%, respectively, for each of the four years while work hours increased by 56%. The per-year savings breakdown for the employers were $469,990; $678,337; $1,936,105; and $1,995,759.

The program includes assessment of potential new hires and adaptation of job tasks (transitional work), when indicated by the risk assessment, education, and ergonomic and engineering remedies to identified problems.

The results of the program were published in the October 1999 issue of the Journal of Occupational & Environmental Medicine. Its lead author was J. Mark Melhorn, MD, who practices orthopedic surgery of the hand and upper extremities at The Hand Center, in Wichita, and serves as an assistant clinical professor in the orthopedics department of surgery at the University of Kansas School of Medicine, also in Wichita.

What made this program so special that it demonstrated up to a 26-to-1 return on investment?

"I think the keys are to being able to identify the individual’s risk characteristics based on a statistical analysis of age, gender, inherited characteristics (genetics), work activities, home activities, and how those above five items blend together to make the person," explains Melhorn. "We looked at those five items and the medical literature, and have designed a statistical analysis instrument that tells us the person’s risk factor. By using that, along with known job stressors, we were able to intervene before employees had clinical symptoms of muscle pain in the workplace."

That instrument, CtdMAP, is manufactured by Wichita-based Map Managers Inc. The "Ctd" stands for cumulative trauma disorder; "MAP" was chosen because the instrument "tells the employer where he should be going," Melhorn explains. It was specifically designed for musculoskeletal disorders.

How the program works

The program began in January 1995. It was "designed to integrate a traditional occupational medicine clinic (onsite physician) and a disease-specific individual risk assessment instrument for assigning risk and implementing intervention," the authors explain.1

The five-step program was also designed to incorporate current guidelines offered by OSHA and NIOSH (see box, right).

From January 1995 through 1998, a total of 3,152 individuals who were considered for employment as sheet metal mechanics were included in the program. Each individual’s medical history was taken, and was given a post-hire, pre-placement physical exam and individual risk assessment. The CtdMAP contains 137 questions and 56 physical measurements. In a risk range of 1 to 7, 4 is average; 5 to 7 is considered above average for risk of developing musculoskeletal pain.

People with scores of 4 or lower were simply integrated into the work force. Those with scores of 5 and higher were assigned to transitional, or temporary, work. That meant they were given the same job activities, but the number of hours they worked was limited. There was also a limit on the amount of time they could work with power and vibratory tools.

Individuals with a risk score of 6 or higher were allowed even fewer hours with such tools. Those with a score of 7 were limited still further, both in terms of hours on those tools and on the time they spent performing repetitive motions. People with higher risk for lower extremity and back injuries were also instructed in appropriate body mechanics and lifting techniques.

"Those employees at higher risk were given the opportunity to accommodate to the workplace," Melhorn explains. "A pro athlete is not asked to run five miles the first day; he’s allowed to build up to it. There’s no reason to treat employees differently; their job is their athletic component."

After a period of four weeks, all those employees with scores of 5 and higher were re-evaluated by the occupational physician. Those with initial risk scores of 5 or 6 who had no symptoms re-sumed regular work without restriction. Those with an initial risk score of 7 who had no symptoms were then given a risk score of 5, transitional work guidelines for seven days, followed by re-evaluation. After those seven days, if they still had no symptoms they were allowed to perform regular work, with the caveat that they immediately report any symptoms.

The Five Steps of the Intervention Program
1. Organization
      • Employer commitment
      • Prevention committee
      • Medical consultants
2. Data collection and protocols
      • Problem identification
      • Data collection
      • Protocols
      • Ergonomic
      • Medical
      • Educational
3. Risk identification
      • Risk-assessment instrument
      • Individual risk factors
      • Employer or workplace risk factors
4. Risk analysis
      • New data collection
      • Analysis effects
      • Review of protocols
5. Risk resolution plan
      • Recommendations
      • Implementation of change
      • Ergonomic
      • Education
      • Engineering modification
      • Design changes
Repeat steps 3, 4, and 5 for total quality management
Source: Melhorn MJ, Wilkinson L, Gardner P, et al. An outcomes study of an occupational medicine intervention program for the reduction of musculoskeletal disorders and cumulative trauma disorders in the workplace. JOEM 1999; 10:833-846.

What worked best?

The researchers used six outcome measures in their study:

1. Recordable case incidence rate (CIR). The number of OSHA 200 recordable injuries or illnesses that occurred per 200,000 hours.

2. Lost time case incidence rate. Those incidents in the first outcome that resulted in the employee not being able to return to work on the next scheduled workday.

3. Lost time severity incidence rate. The number of workdays away from work of incidents in the first outcome for those who are either unable to return to regular work or for whom the employer is unable to accommodate in temporary restricted work.

4. Airplane production.

5. Costs of the intervention program.

6. Estimated workers’ compensation costs.

All of those were calculated per employee or per 200,000 hours worked. The highlight results were provided above; the complete study gives a detailed breakdown of results in each area, along with an explanation for those results. But for a wellness professional, an even more important question might be: Which were the most effective risk reduction strategies?

"I would say the education component is probably the most beneficial for the dollars spent," Melhorn offers. "The job modification and rotation is best for high-risk individuals; but if you’re looking for the biggest bang for your buck, identifying which people are best suited for education is probably it."

Inside the CtdMAP, Melhorn explains, is a subscale that tells the employer who is more or less likely to respond to education. "So, you can even focus more attention to those specific people"

Melhorn draws other valuable conclusions from the study. "First of all, the employer should be given credit for having the insight that there needed to be some sort control [of injury costs]. After that management commitment, then the key is developing an appropriate instrument that provides you with valid statistics. Our tables have specific recommendations geared to specific numbers; that’s a lot better than just saying, This employee is at risk; now, what do we do?’ That’s what makes this program so powerful. Imagine how much more competitive a company becomes if it saves $2 million or $5 million?"

Melhorn believes that in order for companies to become and remain competitive in the future, they need to realize they can improve their bottom line through occupational medicine intervention programs like the one described in his study. "The best part for me, as a physician, is that the individual employee’s quality of life is better. But the employer also comes out ahead, because he becomes more profitable.

"The U.S. government predicted that by the year 2000, 50% of the American work force would have some sort of occupational injury annually; and that 50% of every gross national product dollar would be spent on occupational injuries. If that pans out, the cost savings achieved through programs like this will be tremendous."

[Editor’s Note: You can reach Mark Melhorn at (316) 688-5656. E-mail: melhorn@feist.com.]


1. Melhorn MJ, Wilkinson L, Gardner P, et al. An outcomes study of an occupational medicine intervention program for the reduction of musculoskeletal disorders and cumulative trauma disorders in the workplace. JOEM 1999; 10:833-846.