Occupational Health and Employee Wellness Work Better Together

By Phyllis Hanlon

It is a familiar refrain. “Let’s be our own best client and only then can we justifiably offer services to outside companies.” Though it makes sense, too many occupational health and employee health programs remain rigidly separate, leaving opportunities for synergy and cost savings on the table. Common protocols and approaches to both internal employee health services and outside occupational health clients will allow cost-effective synergies.

Internal workers’ compensation and related expenses frequently cost healthcare organizations millions of dollars directly and indirectly. By applying an occupational health program’s outcomes-oriented focus, a healthcare organization can save hundreds of thousands of dollars a year. Conversely, the healthcare organization may also employ outstanding employee health practices to external clients without having to reinvent the wheel.

Yet merged, or at least coordinated, employee health and occupational health programs still tend to be the exception. Organizations that profess to be their own best occupational health client too often talk the talk without walking the walk. Much of this can be attributed to the silo mentality that grips many healthcare organizations. Turf wars prevail and differences, rather than commonalities, are singled out.

Yet the two service lines can be merged in whole or simply to address wellness services, population-medicine initiatives, prevention screenings, and the management of work-related conditions.

A review of new approaches to employee wellness in the healthcare industry is a useful starting point. In 2010 and 2011, nursing and residential-care facilities experienced one of the highest rates of lost workdays due to injuries and illnesses of all major American industries, 2.3 times higher than that of all private industry, according to the Occupational Safety and Health Administration (OSHA). A researcher at the University of California, Davis, estimates that work-related injuries and illnesses cost the nation $250 billion every year (ucdmc.ucdavis.edu/publish/news/newsroom/6075), and the growing price tag––to both employees and employers––is attracting the attention of private and public health agencies alike.

GOVERNMENT PROGRAMS OSHA recently launched several initiatives to address work-related injuries and illnesses in healthcare settings, helping hospitals and nursing homes recognize the link between patient safety and worker safety, according to OSHA Program Information Specialist Richard De Angelis.

“In 2012, OSHA launched a National Emphasis Program for Nursing (NEP) and Residential Care Facilities (m3ins.com/assets/documentspdfs/OSHA_National_Emphasis_Program_5913_.pdf) to protect workers from the serious safety and health hazards that are common in these facilities,” Mr. De Angelis said. “Through this program, OSHA is working to reduce worker injuries from repeated manually transferring, repositioning or lifting patients, and we are beginning to see some successes. In this way, the NEP is helping OSHA send a clear message that employers are responsible for finding and fixing these hazards in their workplace.”

An initiative sponsored by the National Institute for Occupational Safety and Health (NIOSH) emphasizes work site and after-hours health. Called Total Worker Health (www.cdc.gov/niosh/twh/), this comprehensive preventative approach addresses workplace risks and worker risks and has led to improved health and lower healthcare spending.

“Addressing workplace health alone is not enough,” said Dr. L. Casey Chosewood, senior medical officer at NIOSH’s Total Worker Health. “[Organizations] must realize that work exposures not only affect people while they are on the job, they are also carried home at the end of the day by workers to their families. This is true with many types of exposures like chemicals or lead, but it is also true with exposures like stress.”

Similarly, health habits arising off the job often affect job performance, Dr. Chosewood said. “Tobacco use, poor diet, alcohol and drug abuse and lack of regular physical activity all affect job performance, increase risks for injury or illness at work and diminish well-being.”

A comprehensive preventative approach targeting workplace risks and worker risks results in improved health, reduced healthcare spending and a better future for employees. “Employers gain a healthier workforce, reduced incidence of illness and injury and increased productivity,” Dr. Chosewood added. In fact, meta-analysis shows that two or three years after implementing this kind of program, a company will be saving roughly three dollars for every dollar invested.

Dr. Chosewood pointed out that in addition to tracking blood pressure, cholesterol and body-mass index, other initiatives should be created with workers’ unique needs and desires in mind. “Not every worker needs or will engage in the same programs. Workers will feel most connected to programs where their needs and voices were heard,” Dr. Chosewood said. “It has more impact when they think about how they can use the currency that better health provides for them.” Social supports, social media, incentives and competitions can also help initiate and maintain strong participation and engagement levels.

Total Worker Health provides guidelines that individual organizations can customize––an approach that is particularly appealing for hospitals. “[Hospitals] have resources others don’t, such as on-site screening, personnel to handle health issues, occupational health structure and other built-in opportunities,” Dr. Chosewood added.

FIVE REASONS TO MERGE YOUR OCCUPATIONAL & EMPLOYEE HEALTH PROGRAMS:

1. To validate your occupational health program by providing best-practice services to your workforce by merging it with your employee-wellness services.
2. To recognize that illness and injury rates for hospitals and healthcare provider organizations are double the national average for all other industries and that such high rates demand an occupational health return-to-work plan.
3. To minimize lost workdays: hospitals (2011 data) had approximately ten lost workdays per work-related injury.
4. To minimize internal costs: $3.9 billion was spent on injured workers; classic occupational health practices are cost-effective for injury management.
5. To take advantage of certified occupational-medicine providers already on staff who provide best-practice care for injured workers.

FIVE REASONS NOT TO MERGE YOUR OCCUPATIONAL & EMPLOYEE HEALTH PROGRAMS:

1. Your organization has an Insurance E mod below 0.50.
2. You have no lost workdays for your injured workers.
3. You have a return-to-work plan with 100 percent participation by all departments.
4. You already have a structured prior-to-hire functional exam process for all employees.
5. You have a 24/7 employee-health provider to evaluate and treat all injured workers outside the ED.

FIVE THINGS THAT CAN MAKE A MERGER WORK:

1. Develop a plan to educate employees on care processes, including when and where to go for care.
2. Identify return-to-work processes and get administrative support for the program.
3. Utilize a nurse practitioner or physician assistant as the employee health provider.
4. Define standards, policies, and procedures for care and develop processes for monitoring outcomes.
5. Establish return-to-work monitoring, care-management processes, and ongoing program development in conjunction with safety, risk management, human resources, the employee-health provider, and the occupational health medical director.

EDUCATIONAL INTERVENTIONS

Massachusetts General Hospital is focusing its occupational health efforts on nurses and personal-care assistants through a program called “Be Well, Work Well.” This one-year work safety and wellness project was created under the auspices of Total Worker Health. Dr. Glorian Sorensen, Ph.D., M.P.H., director of the Dana Farber Cancer Institute Center for Community-Based Research and professor of Society, Human Development and Health at Harvard School of Public Health, leads the program to examine ergonomic factors and devise ways to create and maintain healthy work, nutrition, fitness, and sleep habits. “We’re working with inpatient care units to provide educational on-site interventions,” she said, noting that finding time during a busy workday to disseminate information is one of the biggest challenges. “We’ve done some lectures and provided materials and discussions that fit in with the staff work schedules,” said Dr. Sorensen. “At times we’ve moved to where [nurses] can watch the patient monitors so they could still do their job while talking.”

Dr. Sorensen is also conducting research to better understand how work experience affects people’s health on and off the job. “We are developing and testing interventions to enhance the day-to-day work experience and encourage ownership of your personal health outcome,” she said.

CULTURE OF HEALTH

All occupational health employee wellness programs need to comply with Centers for Disease Control and Prevention (CDC) regulations and guidelines regarding immunizations and other standard practices, but they should also integrate prior-to-hire and return-to-work screenings, according to Donna Lee Gardner, R.N., M.B.A., senior principal with RYAN Associates. “You should consider hiring someone based on functionality testing, someone already able to do the daily tasks,” said Ms. Gardner, “and then do annual reviews of your employees.”

Putting people back to work immediately or as soon as possible after an injury should be a top priority. “But many staff in the hospitals refuse to let people back on the floor until they are 100 percent. This shows no vision, no common sense,” Ms. Gardner said. “For the 10 percent of what she can’t do, [a nurse] could do some other tasks. Hospitals need to look at putting a price on what it’s costing them. They are hemorrhaging billions of dollars.”

Workers’ compensation also causes an enormous drain on hospitals, a situation that could be stemmed with an on-site employee-health department, Ms. Gardner said. “Sending injured workers to the emergency room is no longer feasible. But employee-health departments are typically not open 24/7. An on-site employee-health department should be open 12 hours a day and should handle more than injuries. They should do immunizations and have a wellness component.”

COMPREHENSIVE PLANNING

Dr. Mark Bernard Russi, director of Occupational Health Services at the Yale-New Haven Health System and the Yale Occupational and Environmental Medicine Program, (medicine.yale.edu/intmed/occmed/index.aspx) said that Yale––the fourth largest hospital system in the country––manages all of its occupational health matters in-house, from creating patient-handling protocols and prevention strategies to assessing staffing levels and ergonomic conditions.

The Yale program has safety-training modules that evaluate health and injury risk and create an environment of prevention-focused care. An emergency preparedness and disaster-response component identifies steps necessary to keep workers safe in emergency situations, such as exposure to blood-borne pathogens and bomb threats. “Our prevention basically involves keeping employees from having accidents,” Dr. Russi said.

Employee wellness at Yale is divided into three areas: work environment, prevention, and specific programs. Separate committees collaborate in the management of the larger occupational health programs for the system’s 18,000-plus employees. For example, one committee oversees clinical activities, such as medical surveillance and vaccinations, while another addresses work-related matters including workers’ compensation and return-to-work initiatives.

Fitness initiatives have proven quite successful at Yale-New Haven Hospital. Its 13,000-square-foot, state-of-the-art Livingwell Fitness Center offers high-tech cardio, strength-training equipment and a group-exercise room. It is also the headquarters for many health and wellness programs. A 2011 bike-ride fundraiser garnered $800,000 for the hospital cancer center. Four-hundred and eighty-five employees participated in the ride and its associated training program. So much enthusiasm was generated, 85 percent of participants said they would do so again, 42 percent reported sleeping better during the training, and 28 percent noticed an increase in productivity and energy and a decrease in stress.

This summer, Yale plans to initiate biometric screening for its entire staff; electronic results on cholesterol, blood pressure, body mass index, and personal health-risk screens will be delivered to all participants.

Participation in wellness programs often proves to be a challenge, so in addition to presenting incentives, programs need to be relevant, said Dr. Russi. “Offering a menu of options could bump up the participation rate. For instance, in a classroom setting, the power of the group may be influential for some individuals. Others may benefit from a customized one-on-one program, phone or internet intervention.”

SMALL-SCALE SUCCESS

Large healthcare systems face the greatest challenges in workplace health but smaller facilities have trials too. Elderwood Health Care at Wedgewood in Amherst, NY, is a success story on a smaller scale. This 92-bed residential facility that offers long-term, skilled nursing and rehabilitation services, along with a 35-bed memory-care unit, was experiencing 40 to 50 workplace-related illnesses and injuries annually in the early 2000s. Administrator Anna Bojarczuk-Foy, M.B.A., took a long look at the situation in an effort to help her staff of caregivers.

“What makes us successful is when we view caregivers as an investment,” said Ms. Bojarczuk-Foy. “In addition to the financial benefits of no injuries, we want to make sure the team is not in pain and on the job.” A team of Safety Supporters became the answer. This assembly of staff members from every level and department works to identify problems and solutions. Safety Supporters sought a way to help pregnant caregivers remain safe while working. “The safety board researched the changing body and developed a program for teaching the best way to care for yourself when you’re working and pregnant,” said Ms. Bojarczuk-Foy. “They put together a packet and give it to any staff person who becomes pregnant.” A Health and Wellness Board engages a different department every month on a health topic and devises strategies to address it. “The kitchen focused on eating healthy and distributed recipes for more nutritious meals. The cardiology unit offered blood-pressure readings to staff members,” Ms. Bojarczuk-Foy said. “The nurse management team addressed [stress levels] and provided stress-release tips. They took over the hair salon one day and had free chair massage.”

The programs have led to a 66 percent reduction in on-the-job injuries, from 46 in 2005 to 15 in 2012. For more information, go to www.elderwood.com/locations/wedgewood.php.

HIGH-TECH TOOLS

The use of spreadsheets and paper to manage occupational health and employee wellness programs is almost obsolete, said Dr. Lee Newman, founder of Axion Health, Inc., which provides software, support, and consultation services for occupational health programs. Today’s technology is much more sophisticated.

Software used to be loaded onto each individual computer and maintained separately for every update. Today, web-based software is available immediately online and can be accessed by anyone with the proper password and authorization regardless of geographic location. Dr. Newman explained that web-based software programs are customizable, more efficient than paper and reduce the incidence of mistakes. Plus, training is minimal as computer use for many workers is intuitive today.

Processes within the facility will dictate software features. “You need to look at work flow and understand how much integration with other departments and equipment is needed,” Dr. Newman said. “Another important aspect to consider is the number of sites involved. Many facilities are not a single location, but could involve outpatient, inpatient, or multiple clinics.”

Dr. Newman said employee wellness software should be specifically designed for occupational health practices. “Software for general hospitals does not do a good job. Also, make sure the software has National Institute of Standards certification (www.nist.gov). You want to have this when handling confidential worker information,” he said. “The software should also provide clinical-decision support. As information is entered, the software gives feedback, for instance, telling you the standards of practice, providing pointers on what to do with certain lab abnormalities.”

Depending on the size of the facility and scope of the required software, such a program can be up and running in a few weeks. “For a large healthcare system with 50,000 employees, it takes many more months to be done. It requires more training and integration with other data sources, such as labs and equipment,” said Dr. Newman, noting that costs are highly variable. A strong integrated system that weds occupational health with employee wellness not only takes care of workers but also protects the employer. With the coming implementation of the Affordable Care Act, the time for leveraging occupational health infrastructure for a healthier workforce could not be more opportune. Integrating Occupational Health and Employee Health will be the subject of course seven at RYAN Associates’ 27th Annual National Conference. Dr. Scott Harris, Jennan Phillips, Brian Jones and Margaret Sweigert will serve as faculty. Tim Ross will serve as panel moderator.