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Common Threads of Effective Primary and Secondary Prevention Services

As a few pioneers are starting to report, research indicates returns of three to ten dollars for every dollar invested in onsite injury and illness prevention. Wellness, fitness, front-line ergonomics and functional rehabilitation, and onsite services are low cost and low tech, but have a high impact on processes of the future. High tech and multiple players are showing continuing escalation of costs for health care in several sectors. Maximizing returns in both dollars and in terms of employee health involves a somewhat unique approach to workplace wellness and rehabilitation previously not well understood and seldom utilized.

First, the entire wellness/prevention (both primary and secondary) effort needs to be understood and undertaken as a process, not a program. Back programs, blood pressure clinics and return-to-work programs have limited impact by themselves. But the few locations where all of these services are integrated in a non-adversarial way with a functional orientation are showing the way to true prevention of Cumulative Trauma Disorder (CTD) and lifestyle illness. Many workplaces have seen and captured the cost savings afforded by today’s claims management. A few have even put in to operation a meaningful return-to-work program to complement the number juggle. Extremely few have used these other programs as part of a larger prevention strategy. Those who have been fortunate enough to have participated in one of these types of onsite processes are leading the way to a revolution in truly participative injury/illness prevention and management.

The heart and soul of this prevention process is regular access to a functionally orientated and trusted health professional. This may mean an office, a small exercise facility and certainly contact on the floor of the workplace. The onsite person (the individual leading the process) needs to be genuinely and equally interested and involved with all types of programs and services from WCB, STD, LTD, fitness and safety. The best return on investment (ROI) is achieved when a long-term focus is the goal, rather than the short term dollar. When an employee asks for help with a back problem the first question is “where will we be with this in three months”? Only with this approach will recurrent labour, safety and employee health issues be resolved.

Maximize benefit

This prevention process must focus on the total person and the long-term maximization of benefit for both primary and secondary prevention. We have all seen that claims management and early intervention are effective at saving the short term dollar, we have also seen that it doesn’t help the person, only the payer. The only way to really help the employee is when secondary prevention is the focus, as well as the entire person and how this health problem’s impact can be minimized for the remainder of his/her life.

Maximizing ROI requires a complete reversal of focus of the typical claims management program. To begin with, as already stated, it is not a program, but rather a process with a long term-total-person focus. The onsite person facilitating the process must have only one bias, the worker, and must also have the freedom to move between all levels of the organization. As something of an independent operator this person must be able to “go between” supervisors, management, benefits people and the worker without being restricted by organizational charts and reporting requirements.

If employees point out a problem in a department that needs attention, the onsite kinesiologist must not be required to report to the safety supervisor, who may or may not act on the issue. It is important to be able to go directly to the departmental supervisor with the concerns and recommendations. Similarly, with permission one must be able to discuss the returning employees’ medical condition with the nurse or doctor in order to facilitate workplace changes to accommodate the employees’ needs.

Similarly, it is necessary to be able to work equally with cancer, heart, back and musculoskeletal issues. Personalized ergonomics combined with low-tech functional work conditioning and return to work programs quickly become self-sustaining. One time it is a non-occupational heart problem; the next time, an occupational CTD. One costs the employer more than the other, both cost the employee too much. Neither is acceptable.

Employee participation

With such a person-centered process and the acquisition of trust over time, employees buy in and participate. Whether it be to walk a block a day in the neighborhood or to get more involved in the company safety program, this process starts first at the individual level and then escalates to an organizational level. As employees participate and see positive results in fitness, rehabilitation, ergonomic or safety programs, they are more likely to buy in when they are convinced their overall well-being is indeed the goal, not just “saving a buck”. All levels within the organization, from labour to management, to safety and wellness committees, must come to understand that what is good for the worker, is good for the company.

The trust issue is one of the primary reasons this onsite service needs to be functional rather than diagnostic in nature. If the onsite kinesiologist, ergonomist or exercise therapist can’t dispute a claim with a conflicting diagnosis, but only help resolve it and prevent future occurrences, then trust-destroying conflict is avoided. Company doctors, physiotherapists etc. render, or claim to render, a diagnosis and this has implications for WCB costs, for employee security and for the company’s safety record. By thinking laterally and giving the employee control, most of these claims and conflicts can be avoided. This entire prevention effort is doomed to fail the minute trust is removed from the equation. So what are the goals of this people-centered prevention process that has, at its core, a functionally-oriented person onsite on a regular basis?

To list the most important:

To eliminate or minimize the need for professional presence. Prevention means less CTD’s and less non-occupational illnesses and injuries.

To cultivate self-reliance. You’ll know you are on the right track when the “workers on the floor” start asking for a little help with their idea!

Give employees and workplaces the tools — education, the opportunity to make personal and workplace changes, support for their problems and follow-through to a resolution to redesign their workplace. The workplace is really coming along when individuals and departments embark on local ergonomic issues and production changes for mutual benefit.

When necessary employees rehabilitate themselves. The final “we’ve made it sign” is when the least-likely employees take care of their own rehabilitation with a minimum amount of coaching or help in the way of guidance. Employees, their spouses and their employers develop their own approach and systems for health and injury prevention.

Simply stated, to maximize a company’s ROI, a functionally trained professional is required in the workplace who can develop trust and obtain buy in from even the most unlikely candidates. This is achieved over months and years of dealing with all issues and people, equally and fairly. Upon injury or illness of course you provide effective claims management, but this also provides an opportunity to facilitate the prevention process to target future prevention and total involvement.

Obstacles

With an economic value-added of as much as ten to one what are the obstacles to this ongoing proven process? (i.e., A $10 savings for every dollar invested)

In the workplace the most common obstacles are downsizing, ageing workers and a lack of movement between jobs, which make chronic cumulative trauma disorders more likely.

Management that has other priorities and can’t see the forest for the trees. There are those who are willing to win a case, or save a buck at the cost of trust and future cooperation. If the employee feels ill-treated this time, there will come another time when coope
ration will not be forthcoming. This is likely to affect production as well as benefit costs.

Other obstacles include health care intent on the latest diagnostic tools, the multi-player treatment program and the “we will take care of you” school of helping. The key to this whole process is giving people information and thereby control. For many health care providers, this goes against their training of patient dependence. Helping others learn to help themselves is often a novel, but learnable method.

Lastly is management’s poor understanding of rehabilitation and wellness. Along with any unresolved labor relations issues we find the most common and often most difficult obstacle to long term success. Most people and certainly organized labour, want more control of their personal and workplace health. Most will make quality and informed choices when given the opportunity. In many workplaces having choices is not an option.

This onsite functionally oriented injury and illness prevention and rehabilitation model is not for the faint-hearted. You have to be ready to be on the floor in all the hot spots and meet challenges head on, which usually include some personal emotional investment. This, “in your face,” model of onsite employee help and outreach is definitely a challenge, particularly if you come from a traditionally-managed workplace, but a target of 1000% return has got to make you interested.

Francis Puchalski, M.Sc., CK, PFLC, of P.E.E.R. Services, can be reached through e-mail: peerinc@tbaytel.net