The guiding loss control philosophy that employees who are under less physical strain have a smaller chance of suffering a job-related injury helped Oklahoma-based INTEGRIS Health hold its workers' compensation medical costs steady since 1998 despite an 8 percent inflation rate and a payroll that has more than doubled during that time period.

That philosophy and its practical application helped INTEGRIS earn an Honorable Mention as one of three winners in the third annual National Underwriter Award For Excellence in Workers' Compensation Risk Management program, sponsored by NCCI.

For health care organizations like INTEGRIS–which operates 13 acute care hospitals, 69 physician clinics and other medical facilities across Oklahoma, employing over 9,000 full time–frequent workplace injuries resulting from daily physical strain are often an unfortunate way of life.

Indeed, Bureau of Labor statistics show that health care is second only to manufacturing as the industry that sustains the most non-fatal injuries among workers.

Health care organizations feel effects beyond workers' comp costs when employees are hurt on the job, as nurses and other qualified staff are in short supply, and any work time missed simply compounds that labor challenge, INTEGRIS noted.

“Hospitals nationwide report vacancy rates of 21 percent for pharmacists, 18 percent for radiology technicians, 12 percent for lab technicians, and even 9 percent for house-keeping and maintenance positions, while registered nurses are 11 percent,” INTEGRIS noted in its award essay.

A frequent cause of workplace injuries for health care organizations is the lifting of patients, according to INTEGRIS–which is self-insured, with Midwest Employer Casualty Company providing stop-loss coverage and WorkMed Benefits serving as its third-party administrator.

It doesn't take much weight to present an injury risk, noted INTEGRIS, which reported in its award essay that “in 1993, the National Institute of Occupational Safety and Health revised their recommended weight for industrial lifting by an individual to just 51 pounds.”

William R. Wandel, system vice president of risk management at INTEGRIS, pointed out that nurses are under incredible physical strain when they have to assist, move and turn patients. Even if the patient is of average size, he said, “it is still an enormous weight to maneuver.”

He added that sometimes nurses must essentially lift dead weight if a patient is, for example, groggy from surgery.

The lifting strain is compounded by the makeup of the work force. The INTEGRIS essay noted “the aging of our health care staff, with average ages for [registered nurses] closer to 50 than 40. The physical decline over time, coupled with responsibilities caring for parents and children in addition to work, greatly increases potential for lack of focus and resulting injury.”

To battle these problems, reduce costs and assist workers, INTEGRIS instituted a “No Lift” policy that prompted a major investment to install mechanical lifts to move patients.

The award essay states that in 1997, Mr. Wandel asked for $50,000 to buy safe-lifting equipment, promising a dollar-for-dollar return in workers' comp loss savings. “They agreed,” the essay continues, “and [Mr. Wandel] exceeded his promise, reducing workers' compensation losses from $3.04 million in 1997 to $2 million in 1998.”

In total, Mr. Wandel said INTEGRIS has spent around $3 million on safe lifting equipment and has realized roughly $2 million per year in savings. Back injuries, he said, are virtually disappearing.

Mr. Wandel said INTEGRIS uses two different types of lifts–portable and ceiling track lifts. The organization plans on phasing out the portable lifts wherever possible, he said, as the ceiling track lifts have proven better with respect to patient safety and easing strain on the staff.

The portable lifts, according to Mr. Wandel, also need to be stored (which uses up space) and retrieved (which means physical strain on the staff).

However, Jennifer Milligan, a vocation specialist for workers' comp and risk management at INTEGRIS, noted there may be instances where a patient who needs to be lifted is in a hallway, or somewhere without access to a ceiling track lift, and so some portable lifts will be kept around.

Aside from assisting staff, Mr. Wandel said patients have responded favorably to the lifts. He said patients do not want to feel like they can be dropped–a feeling they are more likely to experience if two nurses of varying heights and strength are attempting to lift or move them.

Additionally, he said one patient remarked that the lift provided a higher level of dignity. The patient, Mr. Wandel recounted, said: “You can't imagine sometimes having four sets of hands touching your body.”

Beyond adding the lifts, INTEGRIS implemented other ways to assist caregivers with moving patients. An air glide lateral transfer mattress, for example, allows caregivers to “move patients safely and effortlessly from bed to gurney to operating room and back throughout the hospitals,” according to the essay.

Mr. Wandel said the mattress uses air pressure to levitate off of a flat surface and can hold 1,200-plus pounds. By using the mattress, he noted, workers can move patients from flat surface to flat surface with just two index fingers.

INTEGRIS has also motorized heavily loaded linen carts for housekeepers, provided computer equipment movers for information technology staff, and set up IV solution tugs for pharmacy team members.

Pointing to the success of these initiatives, the essay reported that in August 2008, INTEGRIS incurred:

o 35 percent fewer claims.

o $14.1 million less in total direct losses.

o 21 percent less average claims cost than the composite benchmark for self-insured companies from Nov. 1, 2002 to Nov. 1, 2006.

Aside from helping workers with lifting and moving, the organization has moved to stop losses before they happen in other ways, including one program that involves education and stretching/strengthening.

Called the Injury Prevention Incentive Program, Ms. Milligan said workers have indicated that doing stretches has made them less tired during the day, in addition to preventing injuries.

According to the essay, the IPIP programs “consist of safety videos, education anatomy/injury prevention for a specific body part, and stretching/stabilizing exercises to strengthen the area.”

This program, the essay noted, required a $23,000 investment but has saved nearly 10-times that–resulting in $214,000 in workers' comp cost cuts.

Mr. Wandel also spoke about providing non-slip shoes for workers in the dietary areas, where slippery floors had been causing injuries. He said slip-and-fall claims have nearly disappeared since then.

The organization is also putting an emphasis on ergonomics to reduce strains in workers. Simple solutions–such as moving a computer screen higher so the midpoint of the screen is ideally situated where the eyes focus when looking straight ahead–can reduce aches and pains in employees, Mr. Wandel said.

He added that adjusting the heights of countertops and using hands-free earpieces for communication devices has also reduced pain in workers.

The essay reported that “six in-house ergonomic specialists evaluate and modify workstations for any employee at any INTEGRIS facility.” Recommended equipment, the essay added, is purchased through a separate ergonomics budget.

Even with loss prevention measures in place, accidents do happen. INTEGRIS has taken measures to effectively treat its injured employees and get them back to work quickly and safely, according to Mr. Wandel, who said he has an occupational health clinic so injured workers can be seen immediately or driven directly to the physician that can provide the best outcome.

He added that INTEGRIS also shows the employee that the organization is thinking about them and wants them to come back to work. Part of this, Mr. Wandel said, is as simple as sending a get well card.

Workers go through phases when they are injured, Mr. Wandel explained, and one phase could be anger. Angry workers may be more likely to turn to a lawyer if they are angry, he said.

But by staying engaged with the injured worker, INTEGRIS has seen a decline in claim litigation, according to Mr. Wandel. He said the organization used to have two full-time law firms managing suits, while now they have just one in-house counsel.

Mr. Wandel emphasized that his success required a group effort. “It takes a committed team to hold the line on workers' comp losses at INTEGRIS,” according to the essay, noting that Mr. Wandel “works with a team of 38 employees in three departments–environmental health and safety, employee health, and disability/risk management–to help cut workers' compensation losses.”

The essay noted that representatives from these departments “conduct immediate injury investigations, perform weekly injury reviews for trending and problem solving, and lead the monthly safety committee meetings for all pertinent department leaders from the metro area hospitals.” The rural hospitals also conduct monthly safety meetings, the essay added.

A key to loss prevention is to make life easier on the workers, according to Ms. Milligan, who said INTEGRIS wants its employees to feel good when they go home, not tired and hurting.

Mr. Wandel said the shortage of health care workers is expected to grow over the next 10 years, so it is important to hold onto those you have by keeping them safe, healthy, happy and productive.

Nurses who are asked to do repeated heavy lifting will not be able to work as the years go on. “We're burning these people out,” he warned.

By implementing strategies to reduce and eliminate such hazardous duty, Mr. Wandel said nurses could be working into their 70s, should they choose to.

Still, in implementing the changes, the INTEGRIS essay noted that “securing cooperation is always a challenge to overcome,” citing “pockets of resistance…in hospital units throughout the organization.”

Therefore, INTEGRIS “needed to find a way to implement new safety equipment usage among those unaccustomed to dealing with change,” the essay said, adding that “bonuses are not the incentive mechanism of choice” at the organization.

Mr. Wandel decided instead upon an allocation program. “As a self-insured organization, the plan was developed to 'pay' each department for safety, with cost savings from decreased workers' comp costs able to be reinvested elsewhere within their budget,” the essay noted.

The program, INTEGRIS added in its essay, “promotes safety accountability by distributing the total workers' comp costs for the prior year back to each individual department.” Mr. Wandel noted that “with safety charges as high as $30,000, most department directors became eager to align with safety goals.”

Looking ahead, INTEGRIS cited needle-stick injuries as being on the rise, requiring “special concentration… to stop the trend.”

“The work of workers' comp cost containment never ends,” the essay concludes.

Special Reports /

INTEGRIS Health Cut Down WC Injuries By Taking Heavy-Lifting Out Of The Job

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