MWCEA Conference Ocean City, Md September 23, 2003 Presented by: Jayne Gribble, PT PFS Jayne.F.Gribble@medstar

1. MWCEA Conference Ocean City, Md September 23, 2003 Presented by: Jayne Gribble, PT PFS Jayne.F.Gribble@medstar.net New Perspectives in Work Injury Management

2. The single most powerful and sensible strategy for decreasing the cost of ‘doing business’ and managing work injuries is PRIMARY INTERVENTION… The PROACTIVE Prevention of the Initiation of Injuries Injuries CAN be Prevented… You Break It You Buy It $

3. Primary Intervention can Reduce Lost Time Days 60-70% - a Significant Return on Investment A Kemper Insurance study revealed 68% savings when direct therapy costs and lost time are calculated

4. The Cost of Breaking It…Show Me theMoney $Direct cost of workplace injuries increased by 2.5% in 2002 (Liberty Mutual Work Place Safety Index) $Between 1998 and 2000 the direct costs grew faster than the rate of inflation (Consumer Price Index) $The frequency of disabling injuries fell by 1% for the same period (Bureau of labor statistics) $Indirect costs total between $3 and $5 for every $1 of direct cost.

5. With costs rising the way they are, shouldn’t there be a renewed emphasis on services that provide value above and beyond traditional clinical services??

6. Value Propositions • Identifying risks on an ongoing basis… • Reduces the frequency and severity of injuries… • Lost time is reduced because injuries don’t have the opportunity to progress to the point of significant tissue damage and inability to perform duties

7. The current clinical model is like… Pushing the Rocks up the Hill

8. A Relatively Small Number of Injuries Consume the most Resources $The top three injury categories accounted for 51% of the direct costs in 2000…up from 46% in 1998. $The top 10 categories accounted for 89% of the direct costs in 2000…up from 86% in 1998.

9. The Top Three Injury Categories Increased in 2000 17% increase in slips & falls 12% increase in lifting injuries 13% increase in body position/use

10. TheGoldenRules for Supervisors Learn to identify unsafe work practices and workstations – be a good role model Improve new worker selection and hire smarter Communicate with and support your human resources Identify power struggles and adversarial interactions early and learn to resolve conflicts

11. Worker safety check Work risk analysis Education and empowerment Wellness programs Job task analysis Pre-placement screen as Fit For Duty/Work Primary Intervention Strategies

12. Worker Safety Check • Individualized • Proactive – prior to a report of injury • Worker or supervisor initiated • Looks both at work practice/behavior and the specific work flow/set up • Specific recommendations and follow up

13. Work Risk Analysis • Comprehensive look at a job class or a specific group of workers • Worker, supervisor or data initiated (i.e. injury trends) • Specific recommendations regarding work flow, set up and risks by body part/region • Worker education must be stressed

14. Worker Selection • Concept: we all use our bodies to earn a living • When being fit is a basic job requirement or is inferred by the description doesn’t it make sense to establish a minimum standard for fitness and ability? • Do we want workers who are capable of performing their duties without undue risk of injury or fatigue?

15. Worker Selection • We can relate fitness to the ability to perform essential job functions • We can also educate individuals to relate fitness to work and know their health risks. • Job tasks such as lifting/carrying and pushing/pulling require components of health such as strength (both absolute and dynamic), endurance and cardiac fitness.

16. Fitness Trivia – the Bad News  Americans continue to deteriorate –this effects general healthcare as well as workers’ compensation costs • 64.5% are officially overweight/obese according to BMI (25-30% is overwgt., >30% obese) (BMI = wgt. x 703 / hgt. squared) 2. Type 2 diabetes has reached pandemic proportions 3. CVD remains # 1 killer for both males and females

17. Worker Selection A Job Task Analysis is CRITICAL to the selection process. • Identify essential/core tasks • Determine frequency and criticality • Determine the fitness factor behind each task • Screen MUST be job-related but does not have to be simulated

18. Worker Selection • Tests, standards and programs are meant to and can discriminate if job relatedness is established and documented. • Are companies ethically responsible for hiring and retaining employees who are physically capable of performing essential functions?

19. Worker Selection - Considerations • Combine with education, wellness andempowerment • Adverse impact may occur but is not illegal since the skills are job-related • Implies emphasis on fitness post-hire as well – change in company culture • What are the consequences of being ‘unfit for duty’??

20. The Process • Informed consent -employment contingent • Fitness assessment – part of pre-employment physical • Musculoskeletal factors such as flexibility and body mechanics cannot be used to discriminate but are useful for education and motivation • Absolute, dynamic strength and aerobic fitness tests can discriminate

21. The Results – Options • Reported to Human Resources • Response based upon established company policy • Hire without bias based upon results • Hire with bias – retest near end of probation period • Offer placement in more appropriate position if available • Reasonable accommodation may apply

22. Fitness Trivia – the Good News  • Exercising to increase your heart rate 30 minutes a day three days per week will reduce your risk of death from CVD and cancer by 50-58% • Increasing the intensity of your current workout by 50% will improve your fat loss by 53% Source: Cooper Aerobics Institute

23. If Your PRIORITY the creation and maintenance • of a fit and healthy workforce you can… • Decrease costs associated with work injuries • Decrease costs associated with general healthcare and disability BUT… If you keep doing what you have always done you will keep getting what you have always got. Do you like what you have been getting? Thank You