Volume 17

Integrated approach puts money in the bank

By Brant Couch, CPA, CIC

Employee safety in the healthcare workplace is inextricably linked to patient safety.

Patient safety, according to Wikipedia, “…is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events.” With the World Health Organization calling patient safety an “endemic concern”, it is little wonder this new discipline has been growing rapidly.

While a purely anecdotal observation, it appears the attention, effort and resources being brought to bear on improving patient safety far exceed what is being applied to employee safety.

Is med-mal driving patient safety reform?

The number of malpractice suits and the amount of damages paid out have most certainly had a lot of influence on the current state of affairs. (In 2012, the number of med-mal cases totalled 12,142 and payouts totalled $3.6 billion.)

And it definitely doesn’t help matters much when a doctor is sued for malpractice because a cow they own wanders into traffic and causes an accident! (See side bar story: Cow sued for malpractice… only in Texas!)

A big picture of employee injuries and costs

To get a sense of the size of the employee safety challenge, let’s consider these 2011 statistics from OSHA:

• U.S. hospitals recorded 6.8 work-related injuries and illnesses for every 100 full-time employees… making a hospital one of the most hazardous places to work
• U.S. hospitals recorded 58,860 work-related injuries and illnesses that caused employees to miss work.
• In terms of lost-time case rates, it is more hazardous to work in a hospital than in construction or manufacturing
• 8 of 10 nurses say they frequently work with musculo-skeletal pain

Source: Bureau of Labor Statistics

If more incentive is needed, consider the costs. OSHA reports:

• $15,860 – $22,300 is the average workers’ compensation claim for a hospital injury between 2006 and 2011
• The average hospital experiences $0.78 in workers’ compensation losses for every $100 of payroll… an annual national total of $2 billion
• 24 percent of nurses and nursing assistants change shifts or take sick leave to recover from an unreported injury
• $27,000 to $103,000 is the estimated cost of replacing a nurse, including separation, recruiting, hiring, orientation, and training
• Some estimates also account for lost productivity while a replacement is hired and trained. Injuries and stress are common reasons why nurses leave the profession

The fact is employees and patients fall victim to many of the same hazards. The most frequent form of employee injury is overexertion and the most frequent cause of overexertion is manual lifting of patients. Improper manual lifting puts patients at risk of falls, fractures, bruises, and skin tears. Additionally, fear or reluctance to move patients can lead to pressure ulcers.

OSHA reports that patient satisfaction levels are higher in hospitals where fewer nurses are dissatisfied or burned out. And, “caregiver fatigue, injury, and stress are tied to a higher risk of medication errors and patient infections.”

The economics of safety

While no definitive national study has been conducted to assess the link between employee and patient safety, the case is being taken up by a growing number of entities. For example, a monograph published by The Joint Commission in 2012, attempts to “bridge safety-related concepts and topics that are often siloed within the specific disciplines of patient safety/quality improvement and occupational health and safety.”

And, according to OSHA, implementing an injury and illness prevention program leads to exceptional results for employees, patients and budgets. Some of the examples cited include:

• Investing $800,000 in a safe lifting program, netted Stanford University Medical Center a five-year savings of $2.2 million
• Tampa General Hospital’s lift teams have used mechanical lifting equipment to reduce patient handling injuries by 65 percent and associated costs by 92 percent
• By implementing a safe handling program, a small hospital in South Carolina cut turnover of older nurses by 48 percent and saved $170,000 on associated costs.

HealthSure’s preventative resources help

Because of HealthSure’s unmatched focus on healthcare, we know how to get the very best employee and patient safety resources into the hands of our clients. Simply said, we know what to ask for when it comes to gaining access to the very best safety training, systems, and tools carriers and other providers have to offer.

Additionally, HealthSure’s participation in HOTComp and similar programs gives us access to frontline safety information and innovation initiatives. If you would like to discuss your employee and patient safety opportunities, call us at (888) 665-1539.

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Research and experience shows a healthcare organization can improve and maintain high safety standards – for patients and employees – only when its leaders visibly, vigilantly and continuously lead the way.

Here are 10 strategies to help your organization create a culture of safety:

1. Walk the talk on the importance of employee and patient safety. It is essential for the CEO to share his or her vision with the entire organization and be seen on the front lines, educating staff and communicating the organization’s direction.
2. Elevate safety to the over-arching priority for your organization. While it may seem counter-intuitive to ask employees to prioritize safety over any other corporate goal (including cost savings, productivity and profitability), doing so can have a profound positive effect on all measures of performance and success.
3. Create benchmarks and track improvement. By first setting the bar for what your culture looks like and then tracking meaningful change, you will be able to quickly find out what works and doesn’t work. Benchmarking is essential to avoid wasting time and money on ineffective initiatives.
4. Give your people the right to decide. Progress is accelerated when every employee has the confidence and appropriate authority to be a meaningful participant in a culture of safety.
5. Get everyone’s input while developing rules, procedures, systems and guidelines. Every individual and group knows what needs to be done.
6. Banish exemptions. Even the smallest, least significant bypass of the safety procedures you put in place undermines the integrity of the entire system.
7. Listen to everyone. Act on what you hear. A simple and safe process for anyone to voice a complaint or a suggestion must exist. When concerns and inquiries are made, the appropriate consideration must be given.
8. Drive continuous improvement. When something happens, you must focus on improving the system and finding new ways to encourage everyone to embrace change.
9. Reaching a set of goals is not the end… it’s just the beginning. Sustaining a culture of safety is a never-ending effort and doesn’t end once certain goals have been reached.
10. Plan for leadership succession to ensure the culture of safety you create becomes a legacy of safety for generations to come.

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The easiest way to save money and reduce costs is to prevent accidents from occurring in the first place. But, when a workplace accident does occur, there are ways for employers to mitigate the costs of a claim.

If an injury to an employee is due to the negligence of a third party, you may be able to have the costs of the claim removed from your organization’s accident cost record.

Healthcare providers benefit greatly by keeping the cost of a claim in-house. Injured or ill employees who receive care from the network they are part of, while not reducing the actual cost of the claim, will be contributing to their organization’s revenue. In some cases, premium reductions for in-network care are available.

Bad apples can spoil it for the rest of us. Due diligence to prevent employee fraud and third-party fraud is often part of the service carriers provide. If it isn’t, the HR director is usually tasked with this responsibility.

The best claims management strategy is prevention. The second most effective cost-savings strategy is an effective back-to-work program.

As the master agent for HOTComp, HealthSure participates in quarterly Safety Committee meetings. These meetings enable risk managers from hospitals to discuss safety improvements that can be made based on claims data provided by Texas Mutual. The Safety Committee in turn shares findings and recommendations with the TORCH Insurance Committee.

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