Dollars and sense: Making a case for ergonomics

Managers respond to bottom-line presentation

Are you comfortable talking about "return on investment"? How about "loss run analysis"? Those business concepts may sound like someone else’s job. But if you talk the language of the hospital’s financial officers, you may win unprecedented support for your ergonomics program.

That was the approach taken by Lori Zinnecker, OTR/L, ergonomics specialist in the safety management department at Northwestern Memorial Hospital in Chicago. "You have to know what your problem is and the direction you’re heading. Then you need to know how to justify and present your case to upper management."

Zinnecker used consultants such as ErgoLogix of Portland, OR, to analyze the cost of back injuries. The basic information used to calculate costs, called a "loss run," is available from the hospital’s risk management department.

"What we do is help them figure out exactly how much money they’ve spent over the last three years on workers’ compensation claims for musculoskeletal injuries," says Ken Aebi, ErgoLogix managing director. "We use three years of the most recent workers’ compensation loss runs. We then calculate how much will be spent on lift and transfer injuries over the next three years if no action is taken to mitigate the risk, such as the purchase of lifting equipment," he notes.

The consultants also calculate how much could be spent on equipment, with the cost offset by the reduction in workers compensation claims. Ergonomics could reduce that cost by as much as 70%, Aebi says. "It’s a very simple, straightforward, and unequivocal analysis"

The insurance loss runs contain information about each workers’ compensation claim: the employee’s name, the date and cause of injury, and the total amount spent on the claim. Workers’ compensation information is not covered by the Health Insurance Portability and Accountability Act, therefore, there are no privacy issues related to gathering and sharing the information.

Details may be sketchy

Sometimes, the loss run may have only general information about the claim, and the employee health professional will need to fill in the blanks. Was it a lifting injury in materials management or patient handling? For your analysis, you would want to look at those separately, Aebi notes. "What you quickly figure out in most hospitals, the cost of lift and transfer injuries run between 40% and 60% of the money being spent on workers’ comp costs. It just jumps out at you." Yet most top administrators haven’t seen those numbers. "It’s a surprise to them when they see it," he explains.

"I’ve yet to see a [chief financial officer] look at these numbers and just pass them off. They are aghast at what [workers’ comp] money has already been spent," Aebi points out.

After determining the costs, Zinnecker needed to set some goals. She needed to figure out how long hospital administrators could expect it to take before they would see a return on their investment in ergonomic equipment. She also considered other related costs. "If you’re going to reduce your lost or restricted days, it is helpful to turn them into a money value," she says. "As you’re writing your goals, you want to make sure your return on investment is going to neutralize out pretty quickly."

Assessing needs on the front lines

Meanwhile, as Zinnecker developed her proposal for the hospital administration, she also worked with frontline health care workers in the units. She conducted physical demands assessments to determine the ergonomic hazards. Using forms developed by the Patient Safety Center at the James A. Haley Veterans Hospital in Tampa, FL, she asked employees to describe and rank the difficulty of their daily activities.

Employees were involved as she began to evaluate equipment. She set up an equipment fair with vendors and invited employees to check out the equipment. They filled out questionnaires and commented on the features they preferred. They provided feedback after working with equipment for a 90-day trial period. "You have to incorporate employees when you’re making these recommendations," she says. "You don’t want to bring in equipment and have no one using it."

With a multidisciplinary task force that included infection control, materials management, and biomedical engineering, she thought through the logistical issues of storing and maintaining the equipment, Zinnecker adds. "How do you make sure the slings are cleaned? What are the infection control protocols you’re going to have in place? We had everybody from employee level to manager level on our task force [to consider those issues]," she says.

The financial analysis — along with the physical demands assessment, unit profile, patient handling equipment inventory, and employee feedback assessments — can be conducted in-house or with the help of vendors. The key is to get buy-in from all levels at the hospital, Zinnecker adds. "It comes down to two things. One is justifying the cost. The other is changing the culture."

Need more information?

ErgoLogix, Portland, OR. Phone: (877) 312-7002. E-mail:

VHA Patient Safety Center, Tampa, FL. Web: