How does your organisation respond when employees are injured at work? Beth Wood, vice president, claims cost control consultant for Lockton companies, outlines seven best practices for post-injury management in healthcare.
The healthcare industry continues to be affected by sweeping changes and reform. Employee wellness programs are becoming a staple within organizational benefit plans. 2015 and beyond will most likely bring more focus on the correlation between employee wellness and how post-injury management outcomes and workers’ compensation costs are impacted by an organization’s overall workforce health. Managing employee injuries appropriately when they occur is going to be more important than ever.
In August 2013, the National Institute of Occupational Safety and Health (NIOSH) cited that more than 18 million people were employed in the healthcare sector.
Healthcare organizations are diligent in having robust patient safety and event reporting processes, yet at the same time they may have weaker, or sometimes non-existent, employee safety and workers’ compensation/post-injury management programs. When asked, most employers report that they have workers’ compensation programs that include elements such as return-to-work, and incorporate communications between the injured employee, adjuster, and medical provider(s). However, the reality is that many organizations do not have the time or resources to make workers’ compensation and post-injury management a priority for their injured employees.
There are proven realistic and effective approaches to post-injury management in the healthcare environment. Many of these approaches have been implemented by Lockton clients, either partially or completely, resulting in improved medical outcomes for their injured employees, reductions in lost-time days, shortened disability durations, decreased litigation rates, and lower workers’ compensation costs.
To achieve these types of workers’ compensation program results, healthcare organizations should consider implementing a fully functioning and formal post-injury management approach that includes the following components.
1. Corporate and facility executive leadership support
It is essential that corporate and facility executive leadership effectively communicate the philosophy and goals of the program, outlining the specific team member accountabilities that are required for the program’s success.
It is important for a healthcare organization’s executives to demonstrate that patient safety and employee safety are equally important, from both a prevention and a response perspective. Patient safety and employee safety committees should include the same members, and patient and employee data systems should be compatible, allowing optimal information exchange.
Healthcare organizations should develop employee safety and workers’ compensation program objectives based on data. Determine what is driving the frequency and severity of workers’ compensation costs and set appropriate program goals.
It is paramount that executive leadership understand the trends associated with employee injuries; they should convey and support a message of care and concern for their injured employees and a focus on prompt recovery.
Program goals should be aligned with organization objectives. Those goals should be monitored and program adjustments made in accordance with the success or failure of achieving those goals.
2. Centralization of the post-injury management process
When numerous individuals handle workers’ compensation claims, procedures are not followed in a consistent manner and injured employees are not treated the same, the process does not proceed smoothly. A decentralized approach to post-injury management generally results in late reporting of injuries, delayed recovery for the injured employee, tension between the injured employee and their co-workers/supervisors and, often, increased rates of litigation.
If the post-injury management process is administered by one person (or more if the claim volume and organization structure warrant), the program can then be executed with consistency, efficiency, objectivity, and fairness. Employers have different names for such an individual; Lockton refers to this person as an Injury Counselor.
It is not necessary that the Injury Counselor be a ‘workers’ compensation expert’. That is the job of your insurance carrier or third-party administrator adjuster. It is also not necessary that an Injury Counselor be a ‘medical expert’, although in the case of healthcare organizations having that background does allow for easier communications with the injured employee.
If the Injury Counselor has medical expertise, Lockton recommends that person be cognizant of inherent tendencies that could compromise objectivity. For example, the Injury Counselor may have close working relationships with treating physicians that unknowingly compromise objective treatment of the injured employee. Or, the Injury Counselor may feel that he/she is equipped to serve in a nurse case management role, when asking an outside party to perform those functions would serve the injured employee better.
In order for this approach to work effectively, the Injury Counselor position, and its function, must be recognized and supported by executive leadership.
3. Execution of a practical, effective transitional duty program by the Injury Counselor
It is not enough for a healthcare organization to say they ‘do return-to-work’. In order for them to have an effective transitional duty program, one that reduces lost-time days, pays out lower wage replacement benefits, and reduces permanent disability, the following must be present:
- An awareness that this effort is important to the organization’s profitability and supported by executive leadership;
- A written policy with suggested timeframes for lost time and restricted duty;
- Job descriptions (that include the physical demands of the job) that are used by the medical providers and the Injury Counselor to facilitate the recovery and return-to-work process;
- A process that systematically determines if an injured employee is making a reasonable recovery (will be able to return to his or her previous job) and provides a contingency plan if not;
- Supervisors who are held accountable for the program’s success in their departments; and
- A comprehensive list of ‘transitional-duty tasks’ that can be used in conjunction with the prescribed restrictions, to guide the return-to-work experience.
4. Alignment with medical providers’ expertise
Medical providers who treat your injured employees must be experts in the principles of occupational medicine, be in agreement with your return-to-work philosophy, and be strong communicators.
It is important the Injury Counselor be allowed access to the medical provider, or their staff, specifically for the purpose of obtaining appropriate return-to-work restrictions. This allows the Injury Counselor to coordinate those restrictions with the various alternative transitional duty options that are available for the injured employee.
The Injury Counselor must also communicate with rehabilitation specialists (eg, physical, occupational, speech therapists) regarding the injured employee’s progression in therapy. It is the responsibility of the Injury Counselor to use this information to strategically guide the injured employee through recovery and, ultimately, a full-duty return to work or maximum medical improvement (MMI).
5. Systematically executed post-injury management procedures that bring consistency to the case management process
While every injury and workers’ compensation claim is different, there are key activities that must be accomplished within certain timeframes every time an employee is injured.
At a minimum, it is important for the Injury Counselor to routinely communicate with the injured employee, and his or her supervisor, the adjuster, and the treating medical provider during the injured employee’s recovery. Depending on the particulars of the claim, the Injury Counselor will communicate with other parties such as nurse case managers, rehabilitation therapists, HR, safety personnel, etc.
If an injured employee is losing time from work, the focus should be on return to work with restrictions. If the injured employee is working with restrictions, the focus should be on achieving a prompt full-duty return to work.
Frequent communication by the Injury Counselor with all parties should result in an opportunity to identify any obstacles to recovery and return-to-work goals.
The focus of those conversations should be on providing information that allows all parties to make informed and objective decisions that allow for the best outcome for the injured employee.
6. Organizational communication
It is essential that the organization’s workforce understand what to expect, and what is expected of them, in the event of a work-related injury or illness. This is the opportunity to set the stage for the Injury Counselor, explaining their role in the workers’ compensation process, its purpose, and how they will assist the injured employee and their supervisor through the process.
This message should be conveyed at the outset of the Injury Counselor program and periodically thereafter. Use all forms of communications that are typically used for organization-wide communications. Consider developing a brochure that can be given to the injured employee at the time of an injury, explaining the workers’ compensation process: roles and responsibilities, what to expect, the transitional duty program, and including a frequently asked questions (FAQs) section.
7. Stay on target and adjust accordingly
Post-injury management program efforts should be periodically monitored to ensure that activities are focused on the right things. Organizations should determine what is driving the frequency and severity of their workers’ compensation claims, develop action plans that coordinate safety and workers’ compensation program objectives, and align with the healthcare system’s operational goals.
Incorporate safety and workers’ compensation program goals into organizational dashboards that are shared with executive leadership. Doing so demonstrates the importance of these programs, highlights their results, and allows for continued support throughout the organization.
About Beth Wood
Beth Wood has been with Lockton since 2000. Her work as a claims cost control consultant focuses on reducing clients’ workers’ compensation costs by helping them enhance their post-injury management programs. She can be contacted at: email@example.com
Beth Wood, Lockton, NIOSH, US