When considering how to create a psychologically healthy and safe work environment, it does require a high level of innovation or new thinking. One can simply look at how workplaces have been addressing physical health and safety for the past several decades.
There are two well-established methods to proactively address health, safety and wellbeing in the workplace: 1) Risk Management, and 2) Wellbeing Promotion. If you consider the public health model approach to disease prevention, wellbeing promotion can be considered a primary prevention intervention, suitable for 100% of employees to reduce illness risk and promote positive mental health. Risk management can be considered a secondary prevention initiative, to identify at-risk employees and groups, and reduce the likelihood and consequence of illnesses.
While risk management and wellbeing promotion activities can be carried out independently of each other, when used together, they increase the chances of positive employee mental health outcomes. Where they fail to prevent a stress-related illness occurring, tertiary prevention interventions should be made available, including counseling (e.g. Employee Assistance Programs), and injury management and return to work provisions.
While risk management and wellbeing promotion activities can be carried out independently of each other, when used together, they increase the chances of positive employee mental health outcomes.
Method 1: Risk Management
Risk Management in relation to psychological health, safety and wellbeing involve four steps:
1. Identify psychosocial hazards – find out what could cause harm, considering recognized psychosocial hazards (e.g. role overload, role clarity, job control).
2. Assess risks if necessary – understand the nature of the harm that could be caused by the psychosocial hazards, the likelihood of it happening and the amount of harm that could be caused.
3. Control risks – implement the most effective control measures that are reasonably practicable in the circumstances.
4. Review hazards and control measures to ensure they are working as planned.
Figure 1: The Risk Management Process
As figure 1 above demonstrates, the risk management process also requires management commitment and consultation with employees, including Health and Safety Representatives (HSRs) if they exist.
When controlling risks (step 3), it is important to reduce risks using higher order controls wherever possible. The Hierarchy of Controls applied to Total Worker Health by the National Institute for Occupational Safety and Health provides a conceptual model for prioritizing efforts to advance worker safety, health and wellbeing (see figure 2 below). Controls and strategies are presented in descending order of anticipated effectiveness and protectiveness. It is an easier model to apply to psychological health and safety than the original hierarchy (which is more specific to physical hazards).
Figure 2: Hierarchy of Controls Applied to Total Worker Health (NIOSH)
FlourishDx helps employers follow a risk management process for the identification and mitigation of psychosocial risks. The platform contains the “Work Design Survey”, which is a short battery of survey scales (86 multiple choice items) to assess employee perceptions of common psychosocial hazards.
Consistent with best practice, and the Thrive at Work framework (developed by the Future of Work Institute at Curtin University), the Work Design survey also assesses positive characteristics of work that promote flourishing, as well as steps taken by the employer to mitigate illness.
Consulting with employees during the risk management process, including the identification of hazards is a WHS legal requirement. The FlourishDx Work Design survey facilitates this process at scale and across geographical diverse work groups.
Method 2: Health Promotion
Workplace health promotion is the process of fostering healthy workplace policies and supportive environments, enhancing positive social conditions, building personal skills, and promoting healthy lifestyles. Physical health promotion at work typically focuses on the five pillars of good health, often abbreviated with the acronym “SNAPS”:
physical activity, and
Health promotion at work typically focuses on policies, education, and behavior change programs to promote the development of these five pillars.
Martin Seligman (often referred to as the godfather of positive psychology – the branch of psychology concerned with wellbeing), has identified five pillars of mental health, often abbreviated with the acronym PERMA:
To promote positive mental health in the workplace, employers should introduce policies, education, and behavior change programs aimed at assisting employees to develop these pillars. But where to start?
FlourishDx contains the “Flourish Survey”. It is a short survey to assess the degree to which individuals have developed PERMA. This can be used as a needs analysis, to determine priorities for intervention at either an individual or group level. At a workplace level, the Flourish Survey results are a leading indicator of mental health, as it has been shown that people with well-developed PERMA are less susceptible to mental illness, and more likely to be flourishing.
The insurance industry uses the term “risk appetite” to describe the level of risk that an organization is willing to accept. An essential first step in managing corporate security, and resiliency, has to do with determining your firm’s risk appetite.
Risk appetite is defined as the amount of risk exposure that an organization is willing to accept as a normal course of business. Tolerance for risk exposure can vary greatly from one company to another, and among different industry segments.
As a precursor to establishing an effective risk management program, it’s essential for a firm to determine its risk appetite. This can be done using a baseline analysis that accounts for a combination of threats, vulnerabilities, consequences, and readiness.
It’s interesting to note that often a company’s appetite for risk doesn’t match its actual exposure. In other words, companies are often unaware that their risk exposure is significantly greater that their actual tolerance for that risk.
Assessments, training, and exercises are all excellent ways to expose those gaps and establish focus points for adjusting your firm’s security posture to align with its risk appetite.
Whilst risk management played a role in business prior to the financial crisis of 2007-2008, it didn’t have quite so much of a major importance as it does today. These days, if a company doesn’t find a way to prevent or mitigate risk then it can really struggle to get back on track. Unexpected risks can shut down a business for days and sometimes even longer, many never even re-open.
Despite the scary facts, it is thought that 75% of businesses today still don’t have a risk management plan in place. Whilst there are many forms of risk management insurance can be one the most important as it helps to prevent losses, and as we all know fewer losses mean higher profits.
How we can help your Risk Management
At Bluedrop Services risk management is taken seriously and we endeavor to meet our client’s requirements to achieve maximum profitability with minimum risk to them. We have implemented a specialist risk management department which will strive to succeed in aiding clients in the process of risk management and how to reduce risk.
Risk management is the identification, assessment, and prioritization of risk followed by coordinated and economical application of resources to minimize, monitor, and control the probability of any unfortunate events, which can occur at any time. The objective of risk management is to assure a company/task does not deflect from achieving its goals.
Risks can come from various sources depending on your type of business, these can include; road risk, potential failure of projects, legal liabilities, financial risk, accidents, deliberate attack, incorrect or no process and procedures, and poor health & safety policies. All of which could have a serious financial impact on a business or body.
Where should you focus your Risk Management?
Emerging companies should focus in particular on employer’s liability, data privacy and cyber liability, errors and omissions liability, directors’ and officers’ liability (D&O) and, depending on the number of employees, fiduciary liability and employment practices liability policies. By identifying and assessing risk early this will reduce the chance of a potential financial impact on a business.
How to reduce your risk
Strategies to manage risk typically include avoiding the risk, reducing the negative effect or probability of the threat, transferring all or part of the risk to another party, and even retaining some or all of the potential or actual consequences of a particular risk.
Although risk management has no measurable improvement on risk there is an increase in confidence in the decisions made by risk management strategies.
Simple risk assessments can be completed to reduce any type of risk, these should include:
1. What is the threat/risk 2. Who is exposed and why 3. Current process 4. What can be done to reduce the exposure 5. Documentation of the above
Sensible risk management is about taking practical steps to protect people from real harm and suffering not bureaucratic back covering. Taking a sensible approach to risk management is about ensuring the safety of employees and public, learning & understanding by all and responsibility of risk by companies.
Employers can provide their employees with a return to work evaluation form to give to their physician when the employee suffers a work-related injury. The form can facilitate communication between the treating physician and employer as to the employee’s status and capabilities. Many employers miss this step.
We encourage employers to send the physician the employee’s current job description AND a job description for an alternative duty position for which the injured employee might be eligible.
What is the importance of a return to work evaluation form?
It’s difficult to action plan the claim and get the employee back to work when there is no clear understanding of the employee’s injury AND job duties. This form along with the job description helps establish the baseline so all stakeholders can work in concert. This will get the employee back in some productive capacity.
Why should an employer provide this evaluation form?
If an employee is injured, they may not be able to perform their original duties. This return to work evaluation form helps the employer create accommodations enabling the employee to come back to work at the best of their ability.
A frequent (and very costly) mistake employers make is bringing the worker back too fast without having them medically cleared to perform their duties. We recently had an employer tell us their worker was injured playing softball for his recreational team on his own time. The employer never noted the incident formally in their employment records creating an incident. Further, they never had the employee medically evaluated to see how severe the injury may have been. Nor did they have the employee medically cleared to come back in the same capacity. Instead, he took a day off, came back to work too early. Sadly, he threw his back out on the job further, exacerbating the injury. Had the employer properly recorded the incident and had the employee fill out an injury form this would not have become a comp claim.
The original injury was non-compensable as it did not occur at work. It became compensable when he returned to work too early and made the injury worse. Following proper procedures and utilizing a return to work evaluation form would have gone a long way in preventing this type of situation from occurring.
What’s the impact on your workers’ compensation premiums by using a return to work evaluation form?
It creates a formal process around employee injuries that accomplishes several cost savings benefits:
Prevents employees from coming back to work too soon. This saves you from driving up injury rates and costs as the injuries usually become worse.
Facilitates very productive communication between treating physician, the injured employee and your company’s HR staff person.
The goal after every employee injury is to get them back to work in SOME capacity as quickly as possible. This cuts down on the ultimate cost of the claim. Too often we see employers simply file the workers’ comp claim with their carrier then walk away and go back to their regular scheduled programming. Then their experience modification factor gets re-calculated which may result in significant workers compensation premium surcharges.
Can employees abuse the return to work evaluation form?
Employees can abuse this only if the employer allows it to happen.
If the employer:
Meets with the injured employee every 10 days to check in on their healing progress
Makes it clear that the accommodations aren’t temporary
Allows open communication to provide the best accommodations and transition phase possible
Follows up with the physician
There should be no possible chance that the employee would abuse the return to work evaluation form. Truthfully, we see far more abuse when employers have no form and no process for getting the worker back on duty.
Costly catastrophic claims are emerging in the workers’ compensation sector, partly driven by comorbidities and prescribing of expensive brand-name drugs, experts say.
Comp payers must quickly identify seemingly innocuous claims that have the potential to balloon out of control and proactively work to mitigate those costs, they say.
More than 80% of medical costs in workers comp are for claims between $10,000 and $500,000, according to Boca Raton, Florida-based National Council on Compensation Insurance Inc. And although overall comp claims are declining, the number of claims exceeding $10 million in comp jumped to 10 in 2016, according to NCCI, compared with just four during the prior year.
While catastrophic injuries affect those figures, comorbidities, lower-body fractures, back strains, and shoulder injuries can also lead to substantial claims in some cases, experts say.
Comorbidities, such as hypertension and diabetes, can increase the cost of an injury that seemed to be a $30,000 to $40,000 claim to six or seven figures, said Anita Jovic, vice president of operations at Home Care Connect LLC in Winter Park, Florida, which provides home health services for injured workers.
“The injured worker may not know they have an underlying diagnosis,” she said. “For instance, in a crushing injury, if you find out (the worker has) diabetes, that claim balloons. The patient may have a wound that may not be healing as quickly … that prolongs the care.”
“Comorbidities, in general, are something we keep at the forefront of our purview,” said Helen Froehlich, the vice president of case management services for Wayne, Pennsylvania-based Genex Services LLC. “What I have seen have a drastic impact on our claims has been very consistently high blood pressure, obesity and adult-onset diabetes. Being aware of where comorbidity is, whether it has a direct potential impact on that individual case … is imperative.”
Patchez Pirtle, the director of catastrophic services for Owings Mills, Maryland-based Restore Rehabilitation LLC, said she’s seen pelvis fractures, heel fractures, and rotator cuff injuries grow into very expensive claims.
Those injuries don’t “necessarily set off alarm bells, but do tend to become very expensive claims,” she said. Often complications from those types of injuries aren’t realized until the employee has been sitting home for months on pain medications, making it more difficult to get that claimant going in the right direction.
Brand-name medications can be a big concern, said Dan Anders, an attorney, and chief compliance officer for Tower MSA Partners in Delray Beach, Florida, which specializes in Medicare set-asides in workers compensation.
“If there’s a brand-name medication … that comes out during the course of their treatment that the doctor thinks is the next wonder drug, it gets placed on the claim and drives up the cost,” he said. “Opioids, for the most part, are available as generic and may not be too pricey, but it’s the long-term effects … they require a lot more management by a physician, which means more visits, and tend to have side effects. The side effects can increase such that there are more medications being prescribed that are nonopioids to deal with those side effects.”
Injuries like back strains or shoulder trauma, which at the outset seem like a standard claim, can also become catastrophic claims because if the initial treatment doesn’t work, “brand-name medications are prescribed and then pain management escalates into a psychiatric issue,” Mr. Anders said.
The key is identifying which claims could escalate, including those driven by expensive medications, said Amy Bilton, shareholder at Nyhan, Bambrick, Kinzie & Lowry P.C. in Chicago. For example, one of her current cases involves a man in his 20s who had a previously asymptomatic condition become symptomatic due to his exposure to fumes at work, ultimately leading to renal failure. His monthly infusion drug, Soliris — which was the only treatment option — costs $1 million a month. However, she said they’re constantly looking to see if any new drugs or treatment options are in the works.
“This is obviously an extreme example, but that’s what a lot of these (high cost) cases come down to — extreme examples,” she said.
Tracy Ryan, chief claims officer of global risk solutions at Boston-based Liberty Mutual Insurance Co., said in the past 10 years the company has used a predictive model for claims it designates as “slow developing medical” to help identify these types of expensive claims earlier. The model looks at medical bills, comorbidities, pharmaceuticals, and treatments, and by combing through that data constantly, it can send an alert to the claims adjuster to review it before the costs potentially soar.
“We have seen significant reductions that we associate with putting that model in place, and the ability to get nurses on those files sooner, engage with doctors, talk about treatment plans … it’s an area that is always important because (these types of claims) can look innocuous at the beginning.”
Warning signs that a claim may require more scrutiny may also be evident. “You can see the writing on the wall when a worker goes in and asks for an opioid by name — you know you’re in trouble,” said Ms. Bilton. “And intuition is super important. If you feel like the claim could go bad, treat it as if it’s going to.”
Another key is maintaining a “settlement mindset” from the day the claim is filed, according to Mr. Anders, and ensure that you’re clearly communicating with the worker and getting medical case management early on in the claim.
“You should be thinking about what should be addressed in that claim to ensure, of course, that the injured worker gets the treatment that they need, that the treatment doesn’t go beyond what’s reasonable, and that you’re not paying for treatment that’s unrelated to that injury,” said Mr. Anders.