Transcript Ergonomics and Caregiver Safety Issues

Safe Resident Handling for
Administrators: Making the
Business Case
University of Oregon, Labor Education and Research
Center (LERC) and Oregon Occupational Safety and Health
Administration (OR-OSHA)
This material has been made possible by a grant from the Oregon Occupational Safety
and Health Division, Department of Consumer and Business Services
Acknowledgements
Materials for this presentation material made possible by
Oregon OSHA
Veterans Health Affairs
SAIF Corporation
HumanFit
Oregon Nurses Association (ONA)
University of Oregon, Labor Education and Research Center
Back Injury Resource Nurses (BIRN)
National Institute of Occupational Safety and Health
(NIOSH)
Today’s workshop will address
• Why a Safe Resident Handling
(SRH) Program is important
• Why resident handling is hazardous
• Injury Statistics
• Why SRH programs succeed or fail
• Program costs and benefits
• How to measure and evaluate SRH
programs
Learning Objectives
By the completion of this class you should be able
to:
• List costs of developing and implementing SRH
program
• List benefits of SRH program
• Identify common reasons programs fail
• List components of a successful SRH program
Importance of SRH Programs
• Research from numerous
sources has shown there is
no safe way to manually lift
or move a dependent
resident
• Resident handling injuries
are costly for the company
Why is Manual Resident Handling so
Hazardous?
• Physical demands of the
work
– Job exceeds physical
demands of individuals
• Poor equipment and facility
design
• Poor work practices
• Individual characteristics
– Age, past injuries, physical
condition, leisurely activities
What are work-related
musculoskeletal disorders (MSDs)?
• Overuse syndromes, repetitive motion
disorders, cumulative trauma disorders, soft
tissue injuries
• Disorders of the nerves, ligaments, tendons,
muscles, discs, bursa, cartilage, or joints
• Acute, chronic or cumulative injuries
• Work contributes to, or worsens condition
• Examples are carpal tunnel syndrome,
degenerative joint disease, strains, sprains,
disc herniations, and sciatica
What are risk factors for MSDs?
• Risk factors for MSDs include:
– Awkward postures (bending,
twisting, reaching, stooping)
– Static postures
– Heavy lifting
– Sudden shift in load
– Repetitive activities
• Risk is increased in magnitude by
combining risk factors
• Risk increased by repetitive
exposure – cumulative trauma
How dangerous is long term care?
6
5
4
3
2
1
0
Total cases
cases with days
away from work
Nursing and residental care
cases with job
transfer or
restriction
Private Industry
Incidence rates, per 100 full time workers, of nonfatal
occupational injuries and illnesses, BLS 2006
The Prevalence of MSDs
in Oregon Health Care
Accepted Disabling Claims (ADC)
in Oregon Health Care
• MSDs (strains, sprains,
herniations) accounted for half
of the Oregon ADCs between
2001 and 2005
2695
4917
• Resident handling MSDs made
up 27.4% of total ADCs
– Nurse aids = 32.6%
– RNs 14.2%
– Other health aides 5.9%
2223
Resident Handling
Other MSDs
All Other ADCs
“Health care” includes SIC 80 (health services) and SIC 8361 (residential care) Oregon DCBS, IMD, July 2007
Resident Handling Injuries
• MSDs related to resident
handling (2001-2005) 4000
3000
Injuries
– Health aids - 167
– Nursing aids -2,371
– RNs -881
• Most frequent cause of
injury: “bodily reaction
and exertion” (63.2%)
which also includes
overexertion and
repetitive motions
2000
1000
0
Health aid
All Injuries
Oregon DCBS, Information Management Division, July 2007.
Nursing aid
Registered
nurse
Patient Handling MSDs
Resident Handling Injury Statistics
from Typical Oregon LTC Facility
Year
# of
Claims
Medical
Costs
Time Loss
Costs
Time
Loss
Days
Other
Costs*
Total
Incurred
2004
13
$27,239
$2,105
61
0
$29,344
2005
9
$16,231
$455
31
19,218
$35,905
2006
4
$1,546
$856
28
2,500
$4,902
Total
36
$52,562
$4017
132
21,718
$78,296
*Other costs include vocational rehabilitation, attorney fees, awards and settlements
SAIF Corp data
How Costly are MSDs?
• Although insurance covers some direct costs,
they are recouped by insurers in rate changes
over time
• Indirect costs associated are generally MORE
expensive than the injuries themselves and are
not covered
Cost of Resident Handling MSDs
in Oregon
Average resident handling injury costs $11,055 in medical
and indemnity costs over lifetime of the claim
$20,000.00
$16,090.02
$15,000.00
$10,000.00
$10,048.72
$11,950.03
$11,283.38
$9,062.05
$5,000.00
$0.00
Oregon DCBS,
Information
Management Division,
July 2007
health aid
licensed
practical
nurse
nursing aid
other
registered
occupation
nurse
What does Workers Comp
Insurance Cover in Oregon?
Direct Costs Only
Medical costs include
• Medical treatment of injuries
• Drug costs
Indemnity costs include
•
•
•
•
•
•
Time loss costs
Temporary and permanent disability payments
Fatality costs/awards
Vocational assistance costs
Settlement costs
Claim expense costs
Oregon State Workers’ Compensation Division, SAIF Corporation
Patient Handling MSD Claim
Covered Cost Components*
•Implicit within “indemnity”
costs, which comprise 55% of
total claims cost, are time loss
and disability fees
Medical @
Medical
after
closure
Indemnity
@ closure
closure
•Insurance does not pay for
the costs associated with
absenteeism and presenteeism
following an injury.
Indemnity
after
closure
*Statistics cover 1997-2006, with 4012 total claims
Oregon DCBS, Information Management Division, 2007
Discussion
Is cost a barrier to implementing
a SRH program at your facility?
Direct costs are the tip of
the iceberg!
Direct Costs
– Medical costs
– Time loss
– Workers Comp premiums
Indirect Costs
–
–
–
–
–
–
–
–
Lost productivity
Resident injury costs
Retention or retraining time
Reduced morale
Break up work team
Extra overtime
Administrator time to manage claims
Punitive costs/time
Indirect Costs
Overtime
Decreased
productivity
Work stoppage
Poorer workermanagement relations
Poor morale
Clean-up, damaged material
replacement costs
Indirect
Costs
Hiring/retraining costs
Investigation costs
Legal costs
Punitive Costs
Fines
Fear of injury
Material depletion
expense
Recruitment
costs
Orientation Costs
Training time
Employee
benefits
Trainer time
Documenting
time loss
Court time
Attorney fees
Compliance inspections
Reports to state/regulators
Supervisor time
Productivity ramp-up
SRH is Affordable!
Wyandot County Nursing Home (Ohio)
• Developed SRH program with
−Equipment (ceiling lifts, FEB, sit-stand)
−Ergonomic & equipment training
−Worker participation in all aspects
−Sustainability
• Transformed into a zero-lift facility
• No MSDs in > 9-years!
Wyandot Costs & Benefits
• Costs
– $140,000/year workers comp costs 3 years prior to SPH program
– $251,000 on equipment over 4 years (1998-2001)
• Savings
– $100,000 workers comp costs
– $125,000 staff turnover costs (hiring time, training)
• Turnover decreased from 75% to 5%
– $55,000 payroll savings for sick-time and overtime
– $126,000 savings in cost of additional staffing not needed
$406,000 - $251,000 = $155,000 savings over 4 years!
• Benefits
– Enhanced morale
– Increased productivity
– Better quality care (attracted and hired best workers)
SAIF Low Lift/SRH Program
• SAIF program implemented 9/17/2004
• 19 facilities included
– acute care, skilled nursing facilities, assisted living,
residential care, and developmentally/physically
disabled group homes
• Client utilized zero/low lift program, with
policies, in at least one facility or department
SAIF Low Lift/SRH Program
Post Implementation Year
# Facilities reporting
Yr 1
Yr 2
Yr 3
19
14
8
% Reduction
Lift/Transfer Claims Only
Accepted claims
65
68
81
Time loss days
80
97
93
Incurred costs
84
93
93
Accepted claims
31
36
61
Time loss days
42
80
93
Incurred costs
38
69
88
All Claims
MSD injury prevention program in
nursing homes (Collins et al, 2004)
Investment
• $143,556 in equipment and $27,600 in training ($498 and
$77 per employee respectively)
• Trained 288 employees 1 ¼ hours each on equipment use
Results
• MSD claims reduced by 57% from 129 to 56
• Direct injury costs dropped from $441,670 to $277,061
yielding annualized saving of $54,870
• The 10 year net present value of the project at the time of
implementation was $594,605
• Accounting for capital maintenance, retraining, and
training backfill, the adjusted recovery time on investment
= 3 + years, but ROI for some OR programs < 2 yrs
Making the Business Case for a
SRH Program
Demonstrate the Financial Value of
a SRH Program: A systems approach
• Define the problem and outline the goals
– Too many injuries/costs associated with resident
handling
– Need to implement ergonomics based SRH program
• Determine solutions
– SRH policy
– Appropriate equipment
• Collect data to demonstrate a change
– Injury rates & costs, indirect costs, etc
– Anticipated costs and benefits of solutions
• Cost justification analysis
– Return on investment
– Program effectiveness
Humanfit, 2002
What are Costs versus Benefits?
Program Costs
•
•
•
•
•
•
Equipment costs
Installation costs
Maintenance
Equipment supplies
Worker training
Equipment lifespan
Program Benefits
•
•
•
•
•
•
•
•
•
•
Reduced Work comp costs
Reduced turnover
Increased labor pool
Enhanced productivity
Improved morale
More resident care time
Improved quality of care
Decreased resident fall risk
Greater resident satisfaction
Reduced workplace violence
Conduct an Economic Analysis
• Single year
– Cost/Benefit Ratio
– Payback period
– Single year return on investment
• Multi-year pay back
• Profit margin analysis
Humanfit, 2002
Cost/Benefit Analysis
• Cost/Benefit Ratio = Dollar value of benefit (gain/loss)
Dollar amount of cost
Example: Lateral transfer injuries
• Three injuries in past year
• Average injury cost (direct) = $11,000 per worker x
3 = $33,000 (in potential savings)
• Solution investment cost (2 air mats) = $10,000
• Benefit to cost ratio = 3.3
The benefit is over 3 times the cost
Humanfit, 2002
Payback Period
Payback period in years = Cost
Benefit (gain or loss)
Payback period in years = $10,000 = 0.3 years
$33,000
or
4 months
A 2-year (or less) payback on facility wide
resident handling equipment is common
Humanfit, 2002
Single Year Return on Investment
Return on Investment (ROI) = Gain or Loss x 100%
Investment cost
ROI = $33,000 x 100% = 330%
$10,000
Humanfit, 2002
Multi-year Payback
• Issues to consider
– Identify the lifespan of the equipment and
interest rate needed to pay for investment
– Determine future versus present value of the
dollar (inflation costs)
– Determine cost of capital (interest, dividends,
payment to providers of funds)
– Calculate savings in year 1 and subsequent
years with value discounted due to inflation
Humanfit, 2002
Profit Margin Analysis
• Calculate the services that must be reimbursed to
compensate for the loss of profit due to injuries:
– Average profit margin for health care in the US is ~4%
– Average cost of a back injury is ~$25,000
___Injury cost___
= $625,000
Avg profit margin
• This is the amount that has to be found through
service reimbursement or cost cutting to
compensate for loss of profit due to injury costs
for 1 back injury
Humanfit, 2002
What should management know?
Program
Costs?
Injury
Trends?
What Management Should Know:
Annual Costs and Benefits
200000
Cost
150000
100000
50000
0
1
Expenses
2
3
4
5
Program Year
Benefits Saved
Applications Completed
Assembling Data
Use injury data for direct costs
•
•
•
•
•
•
•
•
OSHA 200/300 logs
# incidents, lost work days, restricted work days
MSD type (strain, herniation etc.)
Body part affected
By wing or unit
% of total injuries that are MSDs
% MSDs related to resident handling
% time loss on cases
What Management Should Know:
Injury Trends
$80,000.00
Cost
$60,000.00
$40,000.00
$20,000.00
$0.00
0
# MSDs Reported
1
2
Program Year
# MSD Lost Time Cases
3
4
Cost of MSDs
Know the Trends
Collect data before you start your SRH program to
assess trends
• Lagging Indicators
– No direct correlation to daily activities
– Difficult to directly influence
• Leading Indicators
– Direct correlation to work activities
– Easy to influence or control
– Predicts change in lagging indicators
– Quality indicators
Indicators of Worker
Safety & Health
• Lagging indicators
–
–
–
–
OSHA 200/300 logs
Workers comp claims
First aid cases
Use of temporary staff
• Leading indicators
–
–
–
–
Injury risk indicators (ergonomic assessment)
Employee surveys: symptom surveys & satisfaction
Resident satisfaction
Safety audits
Direct Costs Metrics
• Incident Rates
– Used for comparison within facility and across the
industry
• Lost Workday Case Incident Rates
• Severity Rates
– Tracks changes in lost and restricted work days
Incident Rates
Follow SRH program progress by
• Tracking incident rates over time and compare to previous
rates to give an idea of the program’s efficacy:
IR = (# of incidents per year) x (200,000 hrs of work)
(# of hours worked by employees)
Ex:
3 MSDs x 200,000 hrs
100 employees x (50 wks x 40 hrs)
=3
• Incident rates control for employee population change
and employee hours worked so figures can be compared
between facilities
Lynda Enos, “Cost Justification of Ergonomics Programs,” Central Oregon Occupational Safety & Health Conference 2005
Severity Rates
• Records of changes in injury Severity Rates (SR) can
provide information about whether or not the program is
reducing severity of injuries that still occur:
SR = (# of lost or restricted workdays) x (200,000 hrs of wk)
# of hrs worked by target population
Ex: If MSDs keep 3 employees home for 20, 30 and 50 days,
respectively:
SR = (20 + 30 + 50) x 200,000
= 100
100 employees x (50 wks x 40 hrs)
Lynda Enos, “Cost Justification of Ergonomics Programs,” Central Oregon Occupational Safety & Health Conference 2005
Workers Compensation Costs
• Calculate cost per MSD by type and total MSDs
• Calculate average costs of MSDs by type and total
– i.e. Injury cost/# MSDs
• Look at trends over the last 3-5 years
• Assess impact on Workers Comp premiums
• Gather information from
– Workers comp carrier (SAIF, Liberty Mutual, etc)
– OR OSHA
– Loss Run Report
Indirect Cost Estimates for MSDs
• Based on Oregon data, the average resident lifting
MSD in health care between 1997 and 2006 cost
$11,055 in medical and indemnity costs
• Federal OSHA’s “Safety Pays” model – these direct
costs correlate with an indirect cost of $12,500
yielding a total cost of $23,555
• Indirect costs vary considerably depending on
many situation-specific conditions
$afety Pays, OSHA, 1998
Successful SRH Programs
What makes a
SRH Program successful?
•
•
•
•
•
•
•
•
•
Humanfit, 2006
Management commitment
Employee involvement
SRH policy
Education and Training
Worksite assessments
Hazard identification
Medical management
Program evaluation
Sustainability
Successful Program
Implementation
• Tracks project closely
•
•
•
•
– Identify projects
– Assign responsibility
– Monitor progress
Revisit goals and program plan often
Maintain management support
Maintain energy and enthusiasm
Communicate, Communicate, Communicate!
As program matures (after initial successes and high risk
hazards fixed) use employees teams to audit work areas
and solve problems
Humanfit, 2006
Why do SRH Programs Fail?
• Lack of awareness of equipment
• No program plan or project manager
• Program plan not actively and consistently
implemented and evaluated
• No program coach or champion
• Mismatch between equipment, task, and
resident needs
• Program scope too limited e.g. only
administrative controls
Humanfit, 2006
An Effective SPH Program is
achieved when:
• Goals are met
• Early results are demonstrated and commitment
ongoing
• SRH incorporated into environment of care
programs and the organizational culture
• A proactive program is developed where
ergonomics principles are incorporated into
design/purchase of all equipment and processes
Humanfit, 2006
Facility of Choice (FOC) in Oregon
• FOC certification will verify that a facility has met
criteria for a sustainable SPH program
• Marketing benefits include:
• Safe environment for workers
• Nursing staff change jobs less often
• Safe environment for residents
• Residents cared for in safest way possible
• Enhanced regulatory compliance
• Improved facility efficiency
LTC facilities can apply for FOC certification
once SRH program criteria met
Resources
• National Center for Patient Safety
– http://www.va.gov/ncps/
• Patient Safety Center of Inquiry
– http://www.visn8.med.va.gov/patientsafetycenter/
• National Institute of Occupational Safety and Health
– http://www.cdc.gov/niosh/topics/healthcare/
• OSHA (federal)
– www.osha.gov
– http://www.osha.gov/SLTC/etools/nursinghome/index
.html
• Oregon OSHA: www.cbs.state.or.us/osha/
• SAIF Corporation: www.saif.com/
Wrap up & Evaluation